A septorhinoplasty is a comprehensive surgical procedure that addresses both the internal structure and external shape of the nose in a single operation. This surgery combines a septoplasty, which focuses on functional correction of the nasal septum, with a rhinoplasty, which is the aesthetic reshaping of the external nose. The procedure is designed to provide patients with both improved nasal breathing and a more balanced facial appearance. Integrating these two surgeries offers a single recovery period for enhancing both form and function.
Why the Surgery is Performed
The decision to undergo a septorhinoplasty is typically driven by a combination of functional necessity and aesthetic goals, making it a powerful tool for comprehensive nasal improvement. The functional component addresses underlying structural issues that impede normal breathing. The most frequent medical indication is a deviated septum, where the wall of bone and cartilage separating the nasal passages is crooked, obstructing airflow. Correcting this deviation alleviates chronic breathing difficulties, reduces snoring, and improves symptoms related to sleep disturbances or recurrent sinus issues.
A deviated septum can also cause a visible twist or asymmetry in the external nose, requiring the combined procedure for full correction. Functional septorhinoplasty can also address structural problems like nasal valve collapse or enlarged turbinates, which further restrict the airway. Straightening the internal architecture restores optimal airflow and overall nasal health.
The aesthetic goals of the surgery are to refine the external appearance of the nose. Common concerns addressed include reducing a prominent dorsal hump, narrowing a wide nasal bridge, or refining a bulbous or drooping nasal tip. The procedure can also correct deformities caused by trauma. Because the septum forms the foundational support for the external nose, a combined septorhinoplasty is often required when significant aesthetic changes are planned.
The Surgical Procedure
Septorhinoplasty is almost always performed under general anesthesia, ensuring the patient is comfortable throughout the procedure, which can take between two and five hours depending on complexity. The surgeon chooses between the open or closed surgical approach. The closed technique involves incisions made entirely inside the nostrils, leaving no visible external scars. The open technique uses a small incision across the columella, providing the surgeon with better visibility and access for complex reshaping or significant tip work.
The first phase focuses on the septoplasty component. The surgeon carefully lifts the mucosal lining to access the underlying bone and cartilage. Deviated sections of cartilage and bone are straightened, reshaped, or repositioned to lie in the center of the nasal passages. This step establishes a clear breathing pathway and allows for harvesting straight cartilage, which may be needed later for grafting.
The second phase is the rhinoplasty, modifying the cartilage and bone framework to reshape the nose. This involves removing excess cartilage to refine the tip, shaving down a bony hump, or narrowing the nasal bones. To narrow a wide bridge, controlled fractures (osteotomies) may be performed to move the bones inward. Cartilage grafts, often taken from the septum, may be used to add support, refine the tip contour, or strengthen the nasal valves. Once the structures are complete, the incisions are closed with fine sutures.
What to Expect Immediately After Surgery
Immediately following the procedure, patients experience significant nasal congestion and a feeling of fullness. This stuffy sensation is caused by internal swelling and the presence of internal splints or dissolvable dressings. Discomfort is usually managed effectively with prescribed pain medication and is often described as pressure or a bad sinus headache rather than severe pain.
An external plastic or metal splint is placed over the bridge of the nose to protect the newly shaped bones and cartilage. Bruising and swelling around the eyes and cheeks are common and usually peak within the first 48 to 72 hours. Applying cold compresses to the cheeks and keeping the head elevated helps to reduce this initial swelling and discoloration.
Patients will notice bloody nasal drainage, and a drip pad is worn beneath the nostrils to absorb this. Patients must avoid blowing the nose for at least the first week to prevent bleeding and disrupting the healing tissues. Any necessary sneezing should be done with the mouth open to minimize pressure inside the nasal cavity.
Long-Term Recovery and Results
The first major milestone occurs when the external and internal splints are removed by the surgeon around five to ten days. At this point, the initial bruising will have faded, and the worst of the visible swelling will begin to subside. Patients can return to light work or social activities within one to two weeks.
The nose continues to refine, with the majority of noticeable swelling resolving within the first one to three months. Subtle, residual swelling, particularly in the nasal tip, persists much longer because the tip is the slowest area to heal. The final aesthetic shape and contour of the nose, as well as the full functional result of improved breathing, will not be completely apparent until about nine to twelve months after surgery.
During this long-term healing phase, patients must avoid wearing glasses that rest on the bridge of the nose and refrain from contact sports for at least three months. Follow-up appointments monitor internal healing and manage persistent congestion, which may include using saline rinses. The gradual nature of healing requires patience, but the result is a permanently altered nasal structure that provides both better breathing and a new appearance.