Septoplasty is an operation to straighten a deviated septum, the wall inside the nose that separates the two nostrils. Its aim is not to change how the nose looks, but to open a narrowed airway so you can breathe comfortably through your nose. This article explains why a deviated septum matters, who needs surgery and what recovery involves.
What Is Septoplasty?
The septum is a thin wall dividing the nasal cavity into right and left passages. Its front part is flexible cartilage and its back part is made of thin bony plates. It is covered by mucosa, the moist lining of the inside of the nose. Ideally, the septum sits straight in the midline so that equal amounts of air pass through each nostril.
When the septum bends to the right, left or both sides and narrows one or both passages, this is called a deviated septum (septal deviation). It is very common: most adults have some degree of deviation, but only some have enough to cause symptoms.
Septoplasty is a functional operation. It is performed entirely through the nostrils without touching the outside of the nose, so the shape of the nose does not change and facial bruising is not expected. If a change in outer appearance is also desired, the two procedures can be combined in one session as a septorhinoplasty.
Why Does the Septum Become Deviated?
The cause is not always known. The most common causes are:
- The septum and facial bones growing at different rates, present from birth or developing during growth
- Pressure on the nose during birth
- Nasal injuries in childhood from falls, sports or accidents
- A previous broken nose that did not heal properly
A deviated septum is often accompanied by enlarged turbinates, the ridges on the nasal side walls that warm and humidify air. When the septum bends to one side, the opposite turbinate may enlarge to fill the space, so turbinates are often treated during septoplasty as well.
Who Is a Candidate for Septoplasty?
A deviated septum alone is not a reason for surgery. The decision depends on the symptoms it causes and whether they respond to medication. Surgery is usually recommended for:
- Constant or frequently recurring nasal blockage, especially on one side
- Breathing difficulty that does not improve with nasal sprays and other medications
- Mouth breathing during sleep, dry mouth and snoring
- Recurrent sinusitis caused by the deviation narrowing the sinus openings
- Recurrent nosebleeds from dry, thin lining over the deviated area
- Deviation that prevents another procedure, such as endoscopic sinus surgery
- Being unable to tolerate a CPAP device for sleep apnea because of nasal blockage
Symptoms That Suggest a Deviated Septum
The degree of deviation does not always match the severity of symptoms. These complaints point toward a septal problem:
- Breathing more easily through one nostril than the other
- Blockage that shifts from one side to the other when lying down
- Dry mouth and a burning throat in the morning
- Not getting enough air through the nose during exercise
- A feeling of fullness or pressure in the face, forehead or around the eyes
- Poor sleep quality and daytime tiredness
Nonsurgical Options
Before surgery, most patients try medication to see how much of the blockage comes from swollen lining. Steroid nasal sprays, saline rinses and, if allergies are present, antihistamines can reduce swelling and bring relief. However, these medications do not correct a structural bend in bone and cartilage. Septoplasty is considered for people whose symptoms continue despite medication and whose examination shows a significant deviation.
Long-term nasal blockage is not only a comfort issue. Constant mouth breathing can cause a dry throat, disrupted sleep, daytime fatigue and trouble concentrating, so long-standing blockage is worth evaluating with an ear, nose and throat (ENT) examination.
Septoplasty is generally performed after age 17–18, when nasal and facial growth is complete. In children, a limited procedure that avoids the growth centers may be considered only for deviations that seriously impair breathing. For people with a bleeding disorder or uncontrolled chronic illness, the decision is made together with the relevant specialists.
Preparation and Examination Before Surgery
Because nasal blockage can have several causes, accurate diagnosis comes first. The examination covers your symptoms, which side is more blocked, any history of allergies, the sprays you use and any past injury to the nose.
The inside of the nose is then examined with a light and an endoscope, a thin instrument with a camera. Endoscopy shows not only the front of the septum but also its back portions, the turbinates, the area behind the nose and the sinus openings. Looking again after a decongestant spray shows how much of the blockage comes from swollen lining and how much from bent bone and cartilage. Gently pulling the cheek aside shows whether the nasal sidewall collapses on breathing in.
A CT scan may be requested if a sinus problem is suspected. If allergic rhinitis is suspected, allergy tests are done, because patients may not feel full relief if allergies are left untreated.
Before surgery, keep the following in mind:
- Aspirin, blood thinners and some herbal supplements are stopped for a period beforehand on your doctor’s advice.
- Smokers are advised to stop at least in the period before and after surgery.
- Blood tests and an anesthesia assessment are completed.
- You will be asked to fast for a set time before surgery.
- Surgery may be postponed if you have a fever, a cold or an active sinus infection.
How Is Septoplasty Performed?
The operation is performed under general anesthesia and is completed within 2 hours in most patients. Added procedures such as turbinate reduction or sinus surgery may lengthen it. Everything is done through the nostrils, so there is no visible incision.
The main steps can be summarized as follows:
- A small incision is made inside the nostril at the front of the septum.
- The lining covering the septum and the thin nourishing layer beneath it are carefully lifted off the cartilage and bone.
- The deviated pieces of cartilage and bone are removed, straightened or reshaped and put back in place.
- The L-shaped support along the front and upper edge of the septum, which holds up the outer nose, is preserved. This is important to prevent the bridge from collapsing after surgery.
- The lining is laid back in place and secured with absorbable stitches.
Today, septoplasty is often performed with endoscopic assistance. This gives a clearer view, especially of deviations and bony spurs at the back of the septum, allowing targeted correction.
Turbinate Reduction
Enlarged turbinates can be reduced in the same session, either by shrinking the inner tissue with radiofrequency energy or by removing part of the turbinate bone in a controlled way. The aim is to reduce their size while preserving their role in warming and humidifying the air.
Internal Splints and Packing
At the end of surgery, soft silicone splints are usually placed inside the nose to hold the septum in the midline and prevent the inner surfaces from sticking together. Most have an air channel, allowing some nasal breathing. In some patients, no packing is used at all and the septum is secured with stitches.
Recovery After Septoplasty
Patients usually stay in the hospital for one night and go home the next day. In the first days, a feeling of fullness in the nose, mild blood-tinged discharge, headache and temporary numbness of the upper front teeth are common. Simple pain relievers usually control these, and they ease within days.
The internal splints are generally removed at a check-up after 5–7 days. Most patients can return to desk work and social life within a week. However, healing inside the nose continues for weeks, and crusting and mild stuffiness are expected during this time.
Recommendations during recovery include:
- Do not blow your nose in the first week, and sneeze with your mouth open
- Sleep with your head slightly raised
- Use the recommended saline sprays and nasal care products regularly
- Eat warm, soft foods in the first days and avoid very hot drinks
- Avoid heavy lifting and bending, and stay away from strenuous sports for at least two weeks
- Avoid saunas, steam baths and long periods in hot environments
Easier breathing is usually noticed after splint removal and improves as swelling settles. Full healing usually takes 1–3 months, with crusts cleaned at follow-up visits.
Notes for Patients Traveling from Abroad
Patients coming from abroad should generally plan to stay in Istanbul for about 7 days, so the internal splints can be removed and the first check completed before travel. Flying is generally considered reasonable after this visit, although your surgeon may suggest a few more days if turbinate or sinus work was also done or a long-haul flight is planned. Mild stuffiness during the flight is common. Later checks can be coordinated with an ENT specialist in your home country or through online consultations.
Possible Risks and Important Considerations
Septoplasty is common and generally well tolerated, but as with any surgery, there are risks:
- Nosebleeding after surgery
- A collection of blood between the septal layers (septal hematoma) or infection
- A hole in the septum (perforation)
- Scar bands between inner nasal surfaces (synechiae)
- Temporary numbness of the upper front teeth or palate
- Some deviation remaining and, rarely, the need for a second procedure
- Very rarely, a dip in the bridge of the nose or a change in sense of smell
Seek medical attention without delay if you have bleeding that does not stop or worsens, a high fever, increasing pain and swelling in the nose, complete blockage of the nose or a clear, watery discharge from the nose. A septal hematoma can be treated simply when it is noticed early.
Realistic expectations matter. Most patients whose blockage is caused by a structural deviation report clear relief after surgery. However, if there are accompanying problems such as allergic rhinitis, chronic sinusitis or weak nasal sidewalls, these may need separate treatment. Temporary blockage during colds or allergy seasons after surgery is expected and does not mean the septum has bent again. Regular follow-up helps catch problems early.
Septoplasty: Frequently Asked Questions
Will septoplasty change the shape of my nose?
No. The operation is performed through the nostrils, and the support that holds up the outer nose is preserved, so the appearance of the nose does not change. If the deviation is also visible from the outside, a cosmetic correction can be planned separately.
Can the septum bend again after surgery?
A septum corrected with proper technique stays in place in most patients. However, because cartilage is naturally springy, a small group of patients may develop a slight bend over time. A new injury to the nose can also affect the result.
Will septoplasty stop snoring?
If nasal blockage contributes to snoring, snoring may decrease after septoplasty. However, snoring often also comes from other areas such as the soft palate, uvula and base of the tongue, so the operation alone may not be enough.
Can nasal sprays fix a deviated septum?
No. Sprays can bring temporary relief by reducing swelling of the lining, but they cannot correct a structural bend in bone and cartilage. Long-term use of decongestant sprays can also cause a rebound blockage that resembles dependence.
When can I exercise after surgery?
Light activity such as walking can be started within a few days. Strenuous exercise usually has to wait two to three weeks, and contact sports longer.
Conclusion
Op. Dr. Tayfun Demirel, an ENT specialist, evaluates patients with nasal blockage at the practice in Ataşehir, Istanbul, using endoscopic examination to assess how much the deviated septum contributes to symptoms and to address any accompanying turbinate, allergy or sinus problems. Whether septoplasty is needed, and which method is used, is planned individually based on each patient’s findings. To book an appointment, please get in touch. This article is for informational purposes only; an in-person examination is required for diagnosis and treatment.
