Introduction
Septoplasty is a surgical procedure performed to correct a deviated nasal septum. The septum is the wall of bone and cartilage that divides your nose into two separate nostrils. When this wall is significantly off-center or crooked—a condition known as a deviated septum—it can restrict airflow through one or both sides of the nose, making breathing difficult. A deviated septum can be present from birth or result from a nasal injury. Beyond breathing difficulties, it can contribute to frequent nosebleeds, chronic sinus infections (sinusitis), facial pain, and sleep apnea. Septoplasty aims to straighten and reposition the septum to the middle of the nose, thereby improving airflow, relieving nasal congestion, and enhancing overall quality of life.

Surgical Procedure
Septoplasty is typically performed on an outpatient basis under general or local anesthesia, taking about 30 to 90 minutes depending on the complexity.
The entire surgery is performed entirely through the nostrils, meaning there are no external incisions or resulting scars on the face. The surgeon makes an incision in the mucosal lining (the tissue that covers the septum) inside the nose to access the cartilage and bone.
The mucosal lining is carefully lifted away from the septum. The surgeon then removes, reshapes, or repositions the bent or deviated portions of the cartilage and bone. Once the septum is straightened, the mucosal lining is laid back down over the newly structured septum.
The incision is closed with dissolvable stitches. In some cases, the surgeon may place soft silicone splints or soft packing inside the nose to support the septum in its new, straight position and prevent bleeding as it heals.

Surgical Risks
Septoplasty is a common and generally safe procedure, but it carries standard surgical risks, such as adverse reactions to anesthesia and bleeding.

General Complications
Common and expected side effects during the initial recovery period include:
– Nasal congestion and a feeling of stuffiness, similar to a severe cold, due to swelling and splints.
– Mild to moderate pain or discomfort in the nose and face.
– Bloody discharge or light bleeding from the nose for the first few days.
– Numbness in the tip of the nose, upper lip, or upper front teeth, which is usually temporary.

Rare but Serious Complications
While uncommon, serious complications can occur:
– Septal perforation: A hole may develop in the septum during or after surgery, which can cause a whistling sound when breathing, crusting, or bleeding, and may require further surgery to repair.
– Change in nose shape: Rarely, the removal of cartilage can cause the bridge of the nose to dip (a “saddle nose” deformity).
– Decreased sense of smell.
– Septal hematoma: A collection of blood within the septum that must be drained to prevent cartilage damage.
– Continued symptoms: In some cases, the surgery may not completely resolve the breathing issues, requiring a revision surgery.

Pre-operative Preparation
– Medical Evaluation: An examination of your nasal passages, often using an endoscope, to assess the deviation.
– Medication Adjustments: You must stop taking aspirin, ibuprofen, naproxen, and other blood thinners for up to two weeks before surgery to minimize the risk of excessive bleeding.
– Fasting: If general anesthesia is planned, you will need to fast (no food or drink) starting at midnight the night before the procedure.

Post-operative Care
You will rest in a recovery area until the anesthesia wears off and then go home the same day. You will need someone to drive you. Pain medication will be prescribed to manage discomfort.

Wound Care
– Do not blow your nose for at least a week, or as directed by your surgeon, to avoid dislodging healing tissues or causing bleeding. If you must sneeze, do so with your mouth open.
– If splints or packing were placed, your doctor will remove them at a follow-up appointment, usually within a week.
– Use saline nasal sprays or drops as prescribed to keep the nasal passages moist and prevent crusting.
– Elevate your head with extra pillows while sleeping to reduce swelling.

Diet
You can usually resume a normal diet, but avoid very hot liquids or spicy foods for the first few days, as they can increase blood flow to the face and promote bleeding.

Post-discharge Notes
Initial recovery takes about a week, but the cartilage and nasal tissues can take up to a year to fully settle into their new shape.
– Avoid strenuous activities, heavy lifting, and intense cardiovascular exercise for at least 2 to 4 weeks to prevent an increase in blood pressure that could trigger a nosebleed.
– Wear clothing that fastens in the front rather than pulling shirts over your head.
– Contact your doctor immediately if you experience heavy, uncontrollable nosebleeds, a high fever, severe pain not relieved by medication, or signs of a septal hematoma (worsening blockage and pain).