Septoplasty is performed through the inside of the nose, with no external cuts or visible scarring. The surgery straightens the wall of cartilage and bone (the septum) that divides your two nasal passages, and it typically takes 1 to 1.5 hours from start to finish. About 90% of patients experience meaningful improvement in their breathing afterward.
Before the Surgery
Preparation starts a couple of weeks before your procedure date. You’ll be asked to stop taking aspirin, ibuprofen, and similar pain relievers because they thin the blood and increase the risk of bleeding during and after surgery. Your surgeon will review any other medications or supplements you take and let you know which ones to pause. If you smoke, you’ll need to stop, as smoking slows healing and raises the chance of complications.
On the day of surgery, you’ll follow standard fasting instructions. Most septoplasties are done under general anesthesia, meaning you’ll be fully asleep. In some cases, your surgeon may use local anesthesia instead, numbing just the nose and surrounding area while you stay awake. The choice depends on the complexity of your case and your surgeon’s preference.
Step by Step: What Happens During the Procedure
Everything happens through the nostrils. Your surgeon works with a thin, lighted scope (an endoscope) to see inside the nasal passages in detail. The modern endoscopic technique follows a structured sequence of about ten steps, though the exact approach varies depending on what needs to be corrected.
First, the surgeon injects a numbing and blood vessel-constricting solution into the tissue lining the septum. This controls bleeding and makes it easier to separate the tissue from the cartilage underneath. A small incision is then made on one side of the septum, usually the left, through the thin membrane (called the mucosa) that covers the cartilage.
Through that incision, the surgeon carefully lifts the membrane away from the cartilage on one side, then makes a separate cut in the cartilage itself, slightly behind the first incision. This lets them access and lift the membrane on the opposite side as well. With both sides freed, the deviated portions of cartilage and bone are now exposed and can be trimmed, repositioned, or partially removed. In many cases, the surgeon also addresses a bony ridge along the floor of the nose (the maxillary crest) if it’s contributing to the blockage.
Once the septum is straightened, the membrane flaps are laid back down against the cartilage on both sides. The incision is closed with dissolvable stitches, and thin silicone splints are placed inside the nose to hold everything in position while it heals.
Splints and Packing After Surgery
Most surgeons place internal splints made of soft silicone on either side of the septum. These keep the cartilage stable, prevent blood from pooling between the membrane and cartilage (a complication called a hematoma), and support any repositioned bone or cartilage. Silicone splints can stay in the nose comfortably for up to 10 days, though they’re often removed at your one-week follow-up.
Some surgeons use nasal packing instead of, or alongside, splints. Packing materials range from gauze soaked in petroleum jelly to antibiotic-impregnated strips. Packing tends to feel more uncomfortable than splints and is usually removed sooner. Your surgeon will tell you which option they plan to use and what to expect in terms of nasal congestion while it’s in place.
What Recovery Looks Like
The first two days are the most uncomfortable. You’ll have gauze under your nose to catch drainage, which is a mix of blood and clear fluid. This is normal and usually tapers off within 48 hours. Expect a stuffy, pressure-filled feeling in your nose, similar to a bad head cold. Pain is generally mild to moderate and manageable with prescribed medication.
Around one week after surgery, you’ll return for a follow-up visit. Your surgeon will remove any splints or packing that hasn’t dissolved on its own. Most people can return to light activities like walking and household chores at this point, though your nose will still feel congested as the internal swelling resolves.
Strenuous exercise, heavy lifting, and contact sports are off-limits for about a month. Full healing of the internal tissues takes several weeks, and your breathing will continue to improve gradually during that time as swelling goes down. Some people notice the biggest difference within the first few weeks; for others, the full benefit takes two to three months to appreciate.
Risks and Complications
Septoplasty is considered a low-risk procedure. A large systematic review of the medical literature found that the two most-discussed complications, septal perforation (a small hole developing in the septum) and blood collection under the membrane (hematoma), each occur in roughly 2% of cases. Septal perforations are sometimes asymptomatic, but larger ones can cause a whistling sound during breathing or persistent dryness and crusting.
Other possible but uncommon complications include infection, changes in the shape of the nose, decreased sense of smell, and numbness in the upper teeth or tip of the nose. Significant bleeding requiring a return to the operating room is rare.
Procedures Often Done at the Same Time
Septoplasty is frequently combined with turbinate reduction. The turbinates are soft tissue structures on the side walls of your nasal passages that can swell and contribute to obstruction, especially when the septum has been pushing against them for years. Reducing their size during the same surgery improves airflow beyond what straightening the septum alone would achieve. The combination adds only a small amount of time to the procedure and doesn’t significantly change your recovery timeline.
In some cases, septoplasty is paired with sinus surgery if chronic sinusitis is present, or with rhinoplasty if the external shape of the nose also needs correction. Your surgeon will discuss whether a combined approach makes sense based on your imaging and symptoms.