Septoplasty & Turbinate Reduction — What You Need to Know Before a Nose Operation

A septoplasty is an operation to straighten the partition inside the nose — the nasal septum — when it is deviated and causing nasal obstruction. A turbinate reduction shrinks the turbinates, the gill-like structures inside each side of the nose that warm and humidify incoming air. The two procedures are very commonly performed together because the turbinates on the more open side of a deviated nose are often enlarged in compensation. The operation is done entirely inside the nose — there are no external cuts, no plaster, and no visible scars. It takes around 20 to 40 minutes, is performed under general anaesthetic, and is usually a day-case procedure.

If you are reading this page because of long-standing nasal blockage, Blocked Nose describes the broader range of causes and treatments. If sinus disease is part of the picture, see Sinusitis. If allergic rhinitis is contributing — as it does in many patients — please also read Hay Fever & Allergic Rhinitis. For patients having this operation as part of treatment for obstructive sleep apnoea, see Snoring & Obstructive Sleep Apnoea.

A Brief Anatomy Lesson

The inside of your nose has two air passages separated by a midline partition. The front part of that partition is cartilage (the wobbly bit you can feel just above your top teeth) and the back part is bone. This whole structure is the nasal septum. The septum sits on a small bony ridge called the maxillary crest at the floor of the nose.

On the side walls of each nasal passage are the turbinates — long shelves of bone covered in vascular soft tissue that act like radiators. As air passes over them on its way to the lungs, it is warmed, humidified, and filtered. Turbinates can swell and shrink minute by minute under autonomic nervous control — which is why your nose feels more or less blocked at different times of day. There are three turbinates on each side (inferior, middle, and superior); turbinate surgery in this context usually refers to the inferior turbinates, which are by far the largest and the main cause of blockage.

Approximately 75–80% of people have some degree of septal deviation, but only a minority experience symptoms. The septum may bend to one side, develop a spur where bone meets cartilage, or curve like an S-shape. Where the septum is deviated, airflow tends to be one-sided: the open side carries all the air, and the turbinates on that side often enlarge in response, compounding the problem. This is why a deviated septum can cause blockage that feels worst on the opposite side to the deviation.

A Short Video Guide

Professor Veer's patient guide below covers the operation, the risks, and the practical steps before and after surgery. It runs about twenty minutes. You may find it useful to watch this before reading the rest of the page in detail.

What the Operation Involves

The operation is done entirely through the inside of the nose — modern septoplasty does not require any external cuts. A small incision is made just inside one nostril, the lining of the nose is lifted off the septum on both sides, and the deviated portions of cartilage and bone are removed, repositioned, or reshaped. The cartilage is then swung back into the midline, and any small spurs of bone are trimmed. Dissolvable stitches hold the lining in place.

If turbinate reduction is being performed at the same time, the inferior turbinates are shrunk using a radiofrequency or coblation device — gently coagulating the soft tissue without removing the underlying bone structure. This is a deliberately conservative approach: leaving the turbinate bone intact preserves the nose's ability to warm and humidify air, and substantially reduces the risk of empty nose syndrome.

In a small number of cases — typically where the deviation is severe or there is significant bleeding during surgery — internal plastic splints are stitched temporarily inside the nose to support the septum in its new position. Professor Veer rarely uses these, but they remain standard practice for some surgeons. If splints are used, they are removed in clinic around one to two weeks later.

The whole operation takes 20 to 40 minutes. Total time in hospital is usually around four hours from arrival to discharge.

The Benefits of the Operation

The intended benefit is improvement in nasal breathing. For patients with a clear structural deviation and persistent one-sided or both-sided blockage that has not responded to nasal sprays, the success rate is high: studies consistently show 70–85% of patients report substantial subjective improvement at six months, with objective measurements of airflow showing equivalent gains.

Secondary benefits often include better sleep, less mouth-breathing, reduced snoring, fewer episodes of sinusitis, improved exercise tolerance, a better sense of smell, and improved tolerance of CPAP for patients with obstructive sleep apnoea. For OSA patients, nasal surgery does not usually cure sleep apnoea on its own, but it often makes CPAP usable and may reduce the severity of the OSA itself.

It is worth being honest about what septoplasty does not do. It does not change the external shape of the nose (that is rhinoplasty, a separate operation). It will not eliminate every episode of nasal congestion — colds, hay fever, and humidity all still affect the nose. And it will not improve a sense of smell that has been lost from previous viral infection or chronic sinus disease.

Risks & Complications

The complications below are listed roughly in order of importance. Some are common and minor; some are rare and serious. Please read each one.

1. Bleeding

Some oozing of blood-stained mucus from the nose is universal after septoplasty. It usually settles within seven days, occasionally lasting up to two weeks. Most of what you see is inflammation rather than fresh bleeding; the colour is darker and the volume small.

Significant bleeding during the operation that requires nasal packing occurs in approximately 3% of cases. If packing is needed, it is inserted at the end of the operation while you are still under anaesthetic; you wake up feeling completely blocked on one or both sides. Packing is usually removed within four hours, with a further two hours of monitoring before discharge. A small number of patients with heavier bleeding need to stay overnight with the pack in place.

In Professor Veer's practice, packing is used only in a small minority of cases — perhaps two patients over the last seven to eight years required overnight packing. Modern surgical techniques and instruments have substantially reduced the need for routine packing.

2. Crusting and post-operative congestion

This is the complaint most patients actually notice, even though they tend to worry more about bleeding. The lining of the nose has been disrupted, the microscopic hairs (cilia) that normally clear mucus stop working for several weeks, and the result is large clots of crust that build up inside the nose and block it. Crusting is most prominent in the first two weeks but can persist for six to twelve weeks while the lining heals.

The single most important intervention is regular saline washouts (see Aftercare below). Patients who clean their nose conscientiously typically have a much smoother recovery; patients who skip it often develop infection, prolonged blockage, and occasionally need a return to clinic for instrumental clearance.

3. Infection

Infection of the nasal cartilage is uncommon but serious. The nose has an unusual anatomical quirk: the veins that drain it do not have one-way valves, and there is a direct route from the front of the face back to the cavernous sinus and brain. This means infection here cannot be ignored — minor-looking nasal infections occasionally cause meningitis, brain abscess, or cavernous sinus thrombosis (around 1.6 in 10,000).

Suspected infection presents as worsening pain after the first few days (rather than the expected gradual improvement), tenderness over the nasal tip when pressed, increasing congestion with foul-smelling discharge, fever, or general malaise. If you develop these symptoms, attend A&E or contact your surgeon urgently. Treatment usually involves admission and intravenous antibiotics, not oral antibiotics at home.

4. Adhesions

Where surgery is performed on the septum and the turbinates on the same side, the two raw surfaces can occasionally heal together, forming a band of scar tissue (an adhesion) that blocks airflow. Minor adhesions are easily released in clinic; significant adhesions may need a brief return to theatre. Saline washouts reduce the risk, and most patients have no adhesions.

5. Septal perforation

A septal perforation is a hole in the central nasal septum that does not heal. Small perforations are often asymptomatic. Larger perforations can cause whistling on breathing, crusting, recurrent nosebleeds, and a feeling of obstruction despite the airway being structurally open. Very large perforations can occasionally affect the cosmetic shape of the nose by collapsing the tip.

The risk of perforation in a first-time septoplasty in a healthy patient is low — in the order of 1–2% in published series. The risk is increased substantially by post-operative infection, by previous nasal surgery, by cocaine use (current or past), and by certain inflammatory diseases (granulomatosis with polyangiitis, sarcoidosis, lupus).

6. Cosmetic change to the nose

Septoplasty is not designed to change the external appearance of the nose. In rare cases, however — usually following septal perforation or significant post-operative infection — the nasal tip can collapse, producing a subtle indentation or droop. In Professor Veer's previous patients, no such cosmetic change has been seen following primary septoplasty. The risk is meaningfully higher in patients undergoing repeated nasal surgery (boxers, mixed martial artists), where the cumulative loss of cartilage and bone eventually destabilises the structure.

7. Empty nose syndrome (ENS)

Empty nose syndrome is a paradoxical state in which the nose feels chronically blocked despite being structurally wide open. It is thought to result from excessive removal of turbinate tissue, with loss of the receptors that detect airflow and disruption of normal aerodynamics. ENS is extremely difficult to treat and can cause severe long-term symptoms including breathlessness, dryness, crusting and psychological distress.

ENS was a serious problem in the 1970s and 80s when radical inferior turbinectomies were common — about 20% of those patients developed ENS. Modern conservative turbinate reduction techniques (preserving the bone, gently reducing only the soft tissue) have made ENS very uncommon. It has not occurred in any of Professor Veer's previous patients. The strongest protection against ENS is conservative surgery and prevention of post-operative infection. For more on this condition, see Professor Veer's video on Empty Nose Syndrome and the follow-up discussion.

8. Smell disturbance

Most patients notice a temporary reduction in their sense of smell for several weeks after surgery — usually because the nose is congested with crusting and swelling, exactly as during a cold. This recovers fully once the nose clears.

Permanent loss of smell after septoplasty is rare — approximately 3 in 1,000 — and is thought to be due to inadvertent damage to the olfactory nerve fibres at the top of the nose. If you wake up after the operation thinking your sense of smell has gone, in the great majority of cases this is congestion, not nerve damage, and it will recover.

9. Numbness of the front teeth

A nerve runs along the floor of the nose and supplies sensation to the gum behind the front teeth. It can be irritated during surgery, producing a sensation of numbness in the upper lip or front teeth. This is usually temporary, settling within one to two days. Long-term complete numbness occurs in approximately 1 in 10,000 patients.

10. CSF leak and meningitis

Very rarely, surgery at the top of the septum can disrupt the thin bone separating the nose from the front of the brain (the cribriform plate), producing a leak of cerebrospinal fluid (CSF) into the nose. This appears as persistent clear watery drainage from the nose, particularly when bending forward. CSF leak requires urgent treatment because of the risk of meningitis. If you notice clear watery fluid dripping from your nose after the operation, please contact the surgical team.

11. Eye and vision problems

Very rare reports exist in the medical literature of visual problems after septoplasty. The mechanism is thought to be inadvertent injection of local anaesthetic with adrenaline into the small ethmoidal arteries near the top of the nose, causing temporary spasm of the retinal artery and reduced blood supply to the retina. The total number of such cases worldwide is small. To minimise risk, Professor Veer injects only into the lowest part of the septum, never into the turbinates themselves, and uses lower concentrations of adrenaline. The use of cocaine as a topical decongestant — which carries its own cardiac risks — is avoided entirely.

12. Failure to relieve symptoms

A small proportion of patients have only partial relief of nasal blockage after surgery. The commonest reasons are unrecognised allergic rhinitis (which causes turbinate swelling on top of a structural problem), nasal polyps, sinus disease, vasomotor rhinitis, or simply that the perceived blockage is not coming from structure. Pre-operative assessment with nasal endoscopy and sometimes CT scanning is used to identify these contributors before surgery is offered.

13. Anaesthetic risks

As with any operation performed under general anaesthetic, there are standard anaesthetic risks: nausea, sore throat, allergic reaction, and very rare serious events. These will be discussed by the anaesthetist separately.

Before the Operation — How to Optimise Your Outcome

Three months before — stop smoking and treat sleep apnoea

Nicotine in any form — cigarettes, vaping, patches — impairs mucociliary clearance and substantially worsens healing in the nose. The evidence suggests that stopping three months before the operation produces a clearer benefit than stopping one month before. If you smoke, this is the single most useful thing you can do to improve your outcome.

If you have obstructive sleep apnoea, get your CPAP optimised and use it consistently for at least three months before surgery. Untreated OSA reduces oxygenation overnight, increases physiological stress, and is associated with worse surgical outcomes. See Snoring & OSA for more.

Three weeks before — stop nasal decongestant sprays

Decongestant sprays such as Otrivine (xylometazoline), Sinex, or Afrin (oxymetazoline) shrink the blood vessels in the nose dramatically. Long-term use causes rebound congestion and dependency, and substantially increases surgical risk because the blood vessels are unable to respond normally. Stop these sprays three weeks before the operation and switch to a steroid spray such as Avamys, Nasonex, or Beconase if your symptoms are troublesome. Most surgeons, including Professor Veer, prefer not to operate on patients still using decongestant sprays.

Five days before — stop blood thinners (under medical advice)

Anti-platelet drugs such as aspirin and clopidogrel substantially increase bleeding risk. If you are taking these, the surgical team will tell you when to stop — usually five days before. Do not stop these drugs without checking if they have been prescribed for a cardiac stent or stroke prevention — the risk of stopping may outweigh the bleeding risk. Newer anticoagulants (DOACs such as apixaban, rivaroxaban) and warfarin require specific specialist input, often involving your cardiologist or haematologist.

The night before — eat normally, then nil by mouth

Eat your usual evening meal. From six hours before the operation, take nothing by mouth. "Clear fluids" exceptions are sometimes mentioned but are misinterpreted often enough (squash, fizzy drinks, even alcohol) that the safest rule is: nothing at all. Operations are typically cancelled on the day if you have eaten or drunk anything within this window — please follow the instructions exactly. If the operation is later in the day, the team may give you a small drink of water at a set time, or set up an intravenous line so you do not feel dehydrated.

On the day

Arrive at the time specified — usually a couple of hours before the operation. You will be seen by the surgical team for a final consent check, by the anaesthetist, and by the nursing staff. The operation itself takes 20–40 minutes. Recovery from anaesthetic takes about an hour. After that, provided you have eaten something, passed urine, and feel well, you can usually go home about four hours after the operation finishes.

If your apnoea-hypopnoea index (AHI) is above 15 — meaning moderate-to-severe sleep apnoea — you will normally be asked to stay overnight in hospital so that your breathing can be monitored and CPAP used. Bring your own CPAP machine. Used correctly with humidification turned up, CPAP after septoplasty actually helps the nose heal rather than drying it out.

After the Operation — Aftercare in Detail

What you do in the two weeks after your operation has a substantial effect on the outcome. This section is the most important practical part of this page.

You will look almost normal — but feel blocked

After a routine septoplasty there are no external incisions, no bruising, no plaster on the nose. People around you will not be able to tell you have had an operation. Internally, however, you will feel very congested for the first few days, and gradually less so over the next six weeks.

Saline washouts — four times daily

This is the single most useful thing you can do. Use a NeilMed Sinus Rinse (a squeeze bottle with sachets of buffered saline) four times daily. The technique:

• Mix one sachet with the lukewarm boiled water provided.
• Lean forward over a sink, head tilted slightly down.
• Place the nozzle in one nostril and squeeze gently — not enough to force fluid into the ears or sinuses, just enough to flush water through the nasal cavity and out of the other nostril.
• Repeat on the other side. Spit out anything that runs into the mouth.

This physically washes the crusts, mucus and blood-stained debris out of your nose. Patients describe it as feeling like waterboarding themselves the first time; by day three it becomes routine and pleasant.

Sterimar Hypertonic spray — every few hours

Between the four daily sinus rinses, use a Sterimar Hypertonic spray (or equivalent isotonic saline spray) every few hours — sometimes every fifteen minutes in the first days, then less often as recovery progresses. This keeps the lining moist, prevents crusts forming between washouts, and is much less hassle than setting up a NeilMed each time.

Steroid spray — once or twice daily

A prescribed steroid spray (Avamys, Nasonex or similar) reduces inflammation and helps the lining recover. Start when the surgical team tells you to — usually after the first few days when bleeding has stopped — and continue for several weeks.

Pain relief

Most patients find septoplasty far less painful than expected. Paracetamol four times daily is usually sufficient for the first day or two. Ibuprofen can be added if needed. The majority of patients do not need painkillers beyond 48 hours. If pain is increasing — particularly if it is one-sided and the nasal tip is tender to touch — that is a sign to seek medical advice rather than to take stronger painkillers.

If you feel completely blocked

If despite washouts your nose feels completely blocked because of a large crust, you can return to clinic and the surgeon will remove it with a small instrument — instant relief. If you can't get to a doctor, continue regular washouts; the crust will eventually soften and clear naturally. Do not poke instruments into your own nose; the risk of bleeding outweighs the benefit.

Dissolvable stitches and (rarely) splints

The dissolvable sutures inside the nose holding the septal lining in place soften and dissolve over a week or so. You may feel a small thread hanging from the nostril — leave it alone, or ask a family member or your GP to snip it carefully. Do not use scissors yourself — it is easy to cut the lip or skin. If splints have been used, they will be removed in clinic at one to three weeks.

Lifestyle, Work, Exercise and Travel

Work

Plan for two weeks off work. Many patients are back to office work within a few days, but the recommended two-week interval allows for adequate recovery and reduces the risk of bleeding. Working from home is fine after the first few days.

Exercise

Gentle exercise (walking, light cycling) is fine after the first few days. Avoid any straining activity for two weeks — weight-lifting, high-intensity cardio, heavy lifting at home, and even straining when going to the toilet — anything that makes your face go red. The rise in blood pressure can precipitate bleeding. After two weeks, well over 99% of patients have stopped any bleeding and can resume full exercise.

Travel

Avoid long-distance travel — particularly air travel — for at least two weeks. Bleeding mid-flight is both a medical emergency and an expensive logistical problem. Your travel insurance may exclude cover for up to six weeks after a nose operation; check the small print before booking.

Blowing your nose, eating hot food, exercise

Some surgeons issue long lists of restrictions: no blowing, no hot food, no exercise of any kind. Professor Veer's view is more practical: blow gently if you need to, eat normally, exercise gently as soon as you feel up to it. The only firm restrictions are no straining-type exercise for two weeks, no flying for two weeks, and (this is non-negotiable) no smoking or vaping.

Smoking, vaping, and nicotine

Resumption of nicotine in any form is associated with significantly worse outcomes — slower healing, higher infection rates, and higher rates of nasal scarring. Use the operation as the moment to stop permanently. Nicotine replacement gum or lozenges can be used but should not be relied on long-term.

When to Call the Hospital or Attend A&E

The following symptoms always warrant urgent assessment. Do not wait to see if they settle.

• Worsening pain after the first few days rather than gradual improvement.
• Tenderness over the nasal tip when pressed gently.
• Fever, foul-smelling discharge, or general unwell feeling — possible infection.
• Persistent clear watery fluid from one nostril, especially when bending forward — possible CSF leak.
• Severe headache, neck stiffness, sensitivity to light — possible meningitis.
• Heavy bleeding that soaks through dressings, or bleeding lasting more than a few minutes of firm pinching.
• Sudden visual disturbance — very rare but must be investigated.

Alternatives to Septoplasty

Surgery is rarely the first treatment for nasal blockage. Before recommending septoplasty, conservative treatments will normally have been tried for at least three months:

• Intranasal steroid sprays (Avamys, Nasonex, Beconase, Flixonase) — highly effective for allergic rhinitis and turbinate swelling.
• Antihistamines — for allergy-related blockage.
• Saline rinses — a NeilMed Sinus Rinse used regularly is effective for many patients and can be tried before surgery is considered.
• Allergy avoidance and management — see Hay Fever & Allergic Rhinitis.
• Sinus treatments if sinus disease is present — see Sinusitis.
• Treatment of underlying sleep apnoea — CPAP often improves nasal symptoms by improving overnight oxygenation.

Surgery is usually offered when there is a clear structural deviation, the patient has had adequate trials of medical treatment, and symptoms continue to affect quality of life. For some patients with allergic rhinitis driving the symptoms, surgery may be combined with allergy treatment rather than replacing it.

More Videos on Nasal Surgery

• What you need to know before a nose operation — the patient guide embedded above.
• Septoplasty operation — actual surgical footage from inside the nose.
• Turbinate operations — comparison of techniques for reducing the turbinates.
• How to use nasal antibiotics — if antibiotics are prescribed after surgery.
• Empty Nose Syndrome — explained
• Empty Nose Syndrome — follow-up

Frequently Asked Questions

Booking, Consent and Next Steps

If you are reading this page in preparation for a planned septoplasty or turbinate reduction, please bring any unanswered questions to your pre-operative consultation. The consent appointment is the time to raise concerns about previous nasal surgery, current medications (particularly blood thinners and decongestant sprays), pre-existing nasal issues, and occupational factors that affect timing of surgery.

If you are still considering whether to proceed, the secretarial team can arrange a consultation at 150 Harley Street or Weymouth Street Hospital, or you can book online.