Septoplasty: Overview

The nasal septum is the cartilage and bone partition that separates the left and right nostrils within the nose. In some people, the nasal septum is deviated or crooked, and this can lead to airflow problems. A septoplasty is surgery to correct the deviation in order to improve nasal breathing.

While most surgical outcomes are positive, it's a good idea to be knowledgeable about what to expect from the surgery, especially in terms of the recovery process and the risks involved.

What Is a Septoplasty?

Septoplasty is a common surgical procedure performed by an ear, nose, and throat (ENT) specialist. It may also be performed by a facial plastic surgeon or plastic surgeon, especially if a rhinoplasty (surgery to change the size, shape, and/or symmetry of the nose for aesthetic reasons) is being simultaneously performed. 

A septoplasty may be performed in adults or children. It's typically a one- to three-hour surgery that is done in an outpatient surgical center or a hospital. Conscious sedation is the most common type of anesthesia used.

Patients are discharged home later on the same day as the surgery. If there are complications, such as a bad reaction to the anesthesia or uncontrolled bleeding, a patient may be admitted to the hospital for further observation, but this is rare.

Various Surgical Techniques

With most septoplasties, the incisions are made within the nose—this is called a closed procedure. For more complex cases or for a septoplasty combined with a rhinoplasty (called a septorhinplasty), a small incision may be made across the columella (the small piece of tissue the separates the nostrils)—this is called an open procedure.

There is also the traditional septoplasty, in which a surgeon utilizes a headlight and nasal speculum, versus an endoscopic septoplasty, in which a surgeon utilizes a thin, flexible instrument with a tiny camera and a light on it.

Contraindications

While there are no absolute contraindications to undergoing a septoplasty, people who smoke or people with multiple medical conditions may not be good candidates.

Purpose of Septoplasty

A deviated nasal septum may occur during fetal development or as a result of a trauma or injury to the nose.

While not everyone with a deviated nasal septum experiences symptoms, some do.

These symptoms may include:

• Trouble breathing through the nose
• Dry mouth and chapped lips (from mouth breathing)
• Stuffy nose, especially one side
• Headache
• Snoring, trouble sleeping, and sleep apnea
• Significant nasal drainage which may contribute to recurrent sinus infections

The primary goal of a septoplasty is to straighten the crooked septum in order to alleviate nasal obstruction. In addition to improved breathing through the nose, patients also often note a reduction in nasal drainage and post-nasal drip.

How to Prepare

Determining whether a septoplasty is appropriate for you entails an in-office endoscopy with your surgeon. During this procedure, numbing medicine is sprayed into your nose before a small camera attached to a scope is inserted to assess the space within the nostrils.

If a deviated septum is present and your surgeon believes this is the source of your breathing difficulties and/or snoring or sleep troubles, they may recommend a septoplasty.

If scheduled for a septoplasty, your surgeon will provide you with various pre-operative instructions.

Some of these may include:

• Discontinue blood-thinning medications (such as aspirin and ibuprofen) for two weeks prior to surgery.
• Stop smoking, as it can affect healing.
• Arrange for someone to drive you home after surgery.

What to Expect on the Day of Surgery

Upon arrival on your scheduled surgery date, you will first be taken to a pre-operative room. Here, you will change into a gown, your vital signs will be recorded, and a nurse will place an IV in your hand or arm.

Once taken into the operating room and given medication to go to sleep, your surgeon will perform the following steps: 

• Using small instruments, the surgeon will make an incision inside the wall of one side of your nose.
• The mucous membrane that covers the septum will then be lifted away so the cartilage and bone can be visualized and accessed.
• The surgeon will then straighten the crooked septum by cutting, removing, and/or reshaping the cartilage or bone within the nose.
• The mucous membrane is then repositioned back around the nasal septum and stitched back together with absorbable sutures.
• Soft silicone splints or nasal packs (less commonly) are sometimes inserted into the nostril on each side to help support the new position of the nasal septum.

You will be able to go home after the anesthesia effects wear off and any symptoms, like pain or bleeding, are under control. Your surgeon will provide you with instructions on what activities to avoid and what symptoms to expect during your recovery period.

Recovery

Most people recover from a septoplasty fairly quickly. Any aching nose pain or small amount of bleeding usually subsides within a few days. Most people can return to work or school within a week after surgery when the splints are removed.

Immediately following a septoplasty, your surgeon may advise you to:

• Take your pain medication as instructed, usually either acetaminophen (Tylenol) or an opioid.
• Avoid blood-thinning medications like ibuprofen for two weeks after surgery.
• Avoid blowing your nose.
• Avoid strenuous activity that may increase your risk for nosebleeds.
• Apply a cold compress to your face or nose for any mild swelling.
• Use a nasal saline spray in each nostril four to five times daily for two weeks to optimize healing and to minimize scab formation.
• Use a topical decongestant nasal spray for a few days to help control small nosebleeds and reduce swelling.
• Elevate the head with stacked pillows or a wedge pillow at night.
• Avoid clothing that is tight-fitting and must be pulled over your head.

It's important to follow-up with your surgeon as advised to review your recovery. In some cases, post-operative testing may be arranged two to three months after surgery to reassess conditions like sleep apnea.

Long-Term Care

Recovery from septoplasty is fairly easy; a stuffy nose may persist for up to three months. With a septorhinoplasty or a rhinoplasty, recovery maey take longer. Most notably, swelling—especially at the tip of the nose—can persist for months.

In addition, while most people experience improved nasal breathing, decreased snoring or sleep apnea, and other benefits like a reduction in nasal discharge, post-surgery results may vary.

In some people, the surgical outcome may not be as satisfactory. It is possible for the septum to still be slightly displaced to one side; it may even shift back over time, leading to an incomplete resolution or persistence of symptoms. In these cases, it may be necessary to have a revision of the septoplasty or other interventions to further optimize the response to treatment.

Potential Risks

The potential risks associated with a septoplasty include:

• Infection
• Septal hematoma (a collection of blood within the septum)
• Perforation of the septum (when a hole develops in the cartilage)
• Altered sense of smell
• Numbness in the upper gum or teeth
• Structural change in the nose (e.g., saddle nose or nasal tip drooping)
• Scar tissue formation
• Cerebrospinal fluid (CSF) leakage

A Word From Verywell

For most patients, septoplasty is effective and the outcome is satisfactory. But while this surgery is a common and definitive treatment for a symptomatic deviated septum, it's important to ensure that it is right for you. Take your time in making the decision and sorting out the potential benefits and risks.