Deviated septum surgery, also known as septoplasty, is a procedure for straightening the bone and cartilage in between the two sides of the nose.  This is a very common condition and can cause one-sided or bilateral congestion of the nose on a chronic basis.  Patients will often say the problem is day and night but worse at night when they lie down.  Common complaints associated with a deviated septum include nasal congestion, recurrent nosebleeds, recurrent sinus infections and/or chronic or recurrent sinus headaches because the sinuses can’t properly drain.

The goal of a septoplasty is to reposition the septum in a midline position so both sides of the nose can breathe well and the sinuses can drain properly as well.  Your nose and sinus surgeon/ENT may have to remove or straighten various parts of your septal bone and cartilage to restore normal airflow to your nose.  He may also have to do associated procedures at the same time like turbinate reduction or turbinoplasty, valve or vestibular stenosis repair as well as sinus surgery, if necessary, to make your breathing as good as possible permanently.

Getting Ready for Surgery

When preparing for deviated septum surgery, Dr. Cohen will discuss the benefits and risks with you and obtain informed consent. Medical history is an essential consideration before having surgery as well as a thorough examination including nasal endoscopy and possibly a sinus CT scan, if warranted.

Once it is determined, you are healthy enough for surgery; the doctor will tell you what to avoid. Aspirin, ibuprofen, herbal products and other blood thinners can increase bleeding during the procedure, so do not take these medications one week before your procedure. Don’t forget to let your doctor know of any allergies you have to medications.

The procedure can be completed in the office under local anesthesia if there is a mild deviation, however more severe cases which require significant straightening and work will need to be done under general anesthesia.  If the procedure is done under general anesthesia, then no food or drinks are advised after midnight the night before the procedure.

If your procedure is done under general anesthesia, then a friend or loved one will need to drive you home after surgery and stay with you for a few hours but then you can be left alone.  If the procedure is done in the office under local anesthesia, we still recommend a friend or loved one to drive you home, but some patients have chosen to take Uber or Lyft.

During the Procedure

A limited septoplasty in the office usually takes 15-30 minutes under local anesthesia and there is minor dripping of blood after the procedure and cotton balls are placed in the nose which can be removed a few hours after the procedure at home.  However, a more complete and complicated septoplasty in the operating room will take 30 to 60 minutes, if no cosmetic work is being done.  Usually in these procedures, Dr. Cohen will make an incision on one side or both sides of your nostrils on the inside in order to gain access to the septum. There are no visible incisions made.  He will lift the mucous membrane and move the septum into position and remove or score cartilage and bone as necessary to straighten the septum.  There is no breaking of the nose if no cosmetic work is being done as such there is no outer bruising in Dr. Cohen’s hands.

This is a rather delicate procedure and a premier and awarded nose and sinus surgeon like Dr. Cohen is paramount in having good results.  After the procedure often the mucous membrane is positioned back in place with appropriate amounts of cartilage left behind to provide support and stitches properly placed to make sure all heals straight without perforations or scar tissue.  Lastly Dr. Cohen often places a small splint in the nose to make sure all heals perfectly, which one can breathe through without difficulty.  There is absolutely no packing placed by Dr. Cohen and patients are amazed at how little discomfort they have after wards and no bruising whatsoever or change in appearance, if no cosmetic work is being done.   Lastly all the stitches placed are dissolvable and don’t require removal.  The only thing that needs to be done is to remove the splints 3-5 days after surgery in the office.

Cost of Procedure

A functional deviated septum repair for breathing reasons without cosmetic changes to the nose is covered by insurance except for deductibles and copays if warranted, however if cosmetic adjustments to the nose are required for whatever reason, then these portions of the procedure are not covered by insurance and there is an associated cosmetics fee associated with that portion of the procedure.  The reason for this is that usually those portions of the procedure are done by a dedicated facial plastic surgeon that works with Dr. Cohen and require significant more time for the staff, anesthesiologists and material in the operating room, which insurance does not reimburse for.  As such a separate cosmetics fee is added to the functional parts of the procedure, which is covered by insurance, and will be made clear after consultation.

Possible Risks of Deviated Septum Surgery

There are some very small risks that patients interested in this procedure should know about:

• Scarring
• Bleeding
• Infection
• Septal perforation
• Re-deviation of septum
• Nasal collapse or deformity

These risks are very small and happen in less than 1% of cases in Dr. Cohen’s expert surgical hands, however they are not impossible and all are fixable as well by Dr. Cohen personally.  Of note most plastic surgeons and other ENTs often refer to Dr. Cohen when complications arise and they need help to properly fix the nose once and for all.

Deviated Septum Surgery Recovery

Most people will have pain medication to decrease discomfort after the surgery and may use it for 1-3 days. The nose will remain swollen on the inside and tender for a few days. There is minor bleeding from the nose from the front and back for the first 24-48 hours and usually stops on its own rather quickly.  The initial congestion of the nose from swelling gradually resolves over 2-4 weeks after surgery. There is no outer bruising of the nose if no cosmetic rhinoplasty is done at the time of surgery.

Limiting physical activity helps the healing process and minimizes swelling. Even people who exercised heavily before the procedure must wait until they recover which is usually 1-2 weeks.

The following are some additional tips for a faster and easier recovery:

• Elevate your head while sleeping for the first 24-48 hours.
• Don’t blow your nose for the first week after surgery.
• Rinse you nose/sinuses at least 3 times a day to make sure no scar tissue or infection develops as you heal.

Dr. Cohen will give more specific instructions on your recovery if sinus surgery is combined with your septoplasty.  Also if one of Dr. Cohen’s partners who does facial plastic surgery is involved in your case for cosmetic changes to your nose, then further instructions are given in that respect as well.

As you recover from the surgery, you’ll start to breathe and sleep better and even have more positive energy but it’s a gradual process over 3-6 weeks so patience is key. The healing process can seem slow, but it’s definitely worth it as most patients say it’s a life-changing experience.

Learn More About Deviated Septum Surgery

Dr. Alen N. Cohen, M.D. F.A.C.S. of Southern California Sinus Institue, specializes in deviated septum repair. Call us at 818-888-7878 for an appointment to explore ways we can help you breathe and feel better.