A septorhinoplasty is a surgery that combines two procedures into one: reshaping the outer nose (rhinoplasty) and straightening the internal wall that divides your nasal passages (septoplasty). By addressing both structure and function at the same time, it corrects breathing problems and changes the nose’s appearance in a single operation. It’s one of the most common combined facial surgeries, performed for people who have both a deviated septum and cosmetic concerns, or whose breathing issues can’t be fixed without also restructuring the external nose.
How It Differs From Rhinoplasty or Septoplasty Alone
Rhinoplasty changes the shape of your nose. It can modify bone in the upper portion, cartilage in the lower portion, skin, or all three. Septoplasty, on the other hand, is a purely functional procedure. It straightens the septum, the cartilage-and-bone wall that divides the nasal cavity into two passages, to improve airflow. Neither procedure on its own handles both jobs.
A septorhinoplasty makes sense when a surgeon determines that both are needed. For example, if your septum is crooked and your nasal valves are collapsing, straightening the septum alone won’t fully restore breathing. Sometimes the connection goes the other direction: during a rhinoplasty, surgeons may harvest cartilage from the septum to use as structural grafts for reshaping the nose, even if the septum itself is fairly straight. In revision cases, where a previous rhinoplasty needs correction, this is especially common.
Why Surgeons Recommend It
The functional side of septorhinoplasty targets symptoms that haven’t responded to medications like nasal sprays or antihistamines. The American Academy of Otolaryngology lists several indications: nasal airway obstruction causing mouth breathing, snoring, or sleep apnea; frequent nosebleeds linked to a septal deviation; atypical facial pain originating in the nose; and septal deformities that block surgical access to the sinuses or turbinates.
On the cosmetic side, the procedure addresses bumps on the nasal bridge, asymmetry, a drooping or upturned tip, overly wide or narrow nostrils, or changes from a previous injury. Many patients have a combination: a nose that was broken years ago, healed crookedly, and now causes both visible asymmetry and chronic congestion.
Open vs. Closed Technique
Surgeons use one of two approaches. In an open septorhinoplasty, a small incision is made on the strip of skin between the nostrils (the columella). The skin is then lifted to expose the underlying bone and cartilage, giving the surgeon a direct view of the entire nasal framework. This makes it easier to achieve precise, symmetrical results and to place structural grafts that prevent long-term nasal collapse.
A closed septorhinoplasty keeps all incisions inside the nostrils, leaving no external scar. It works well for more straightforward corrections like removing a bony bump or straightening a deviated septum, but it limits visibility. More complex reshaping, particularly of the nasal tip or cartilage, typically calls for the open approach. Your surgeon will recommend one based on what needs to be done.
Both techniques are performed under general anesthesia and typically take two to three hours, though complex cases can run longer.
Preparing for Surgery
In the weeks before a septorhinoplasty, you’ll need to stop taking medications that thin the blood and increase bleeding risk. The most common ones to avoid include aspirin (and any aspirin-containing products like Excedrin), ibuprofen (Advil, Motrin), naproxen (Aleve), and celecoxib (Celebrex). Your surgeon will give you a specific timeline, but most patients are asked to stop these at least two weeks before the procedure. Blood-thinning supplements like fish oil, vitamin E, and ginkgo biloba are usually on the list as well.
If you smoke, you’ll be asked to quit several weeks beforehand. Nicotine constricts blood vessels and significantly slows healing, increasing the risk of complications.
What Recovery Looks Like
The first week is the hardest. Your nose will be packed with internal dressings and covered with an external splint. Nasal packing, if used, comes out within 24 to 48 hours, which provides immediate relief from the feeling of total blockage. The external splint stays on for seven to ten days to protect the reshaped framework while initial healing takes place.
Swelling and bruising around the eyes peak around day two or three, then gradually fade. Most people feel comfortable returning to work or light activity after about two weeks, though exercise and anything that raises blood pressure are typically off-limits for four to six weeks. You’ll breathe through your mouth for the first several days, and congestion will linger for a few weeks as internal swelling subsides.
The timeline for final results is longer than most patients expect. While the external shape starts looking more normal within a few weeks, complete internal healing and the resolution of all residual swelling takes up to twelve months. The nose continues to refine subtly throughout that year, particularly at the tip, which is the last area to settle.
How Well It Works
A retrospective study published in a peer-reviewed journal measured both cosmetic satisfaction and airflow before and after septorhinoplasty. Patients’ self-rated satisfaction scores jumped from about 31 out of 100 before surgery to 88 out of 100 afterward. Objective airflow measurements told a similar story: average peak nasal airflow increased from roughly 78 to 126 liters per minute, a gain of more than 60%. The improvement in airflow was highly statistically significant.
These numbers reflect what most patients experience: a meaningful and lasting improvement in both breathing and appearance. That said, outcomes depend heavily on the complexity of the problem and the surgeon’s experience.
Risks and Revision Rates
Like any surgery, septorhinoplasty carries risks including bleeding, infection, and reactions to anesthesia. Specific to this procedure, there’s a small chance of septal perforation (a hole in the septum), persistent breathing difficulty, numbness at the nasal tip, or an unsatisfactory cosmetic result.
A large-scale study of over 175,000 septorhinoplasty patients found that 3.1% of first-time patients eventually needed a revision surgery. That rate climbed to 11% for patients who were already undergoing a secondary (revision) procedure. This means the vast majority of patients don’t need a second operation, but revision is more common than in many other surgeries, reflecting how technically demanding nasal surgery is.
Insurance Coverage
Whether insurance covers a septorhinoplasty depends on whether part or all of the procedure is considered medically necessary. The functional component, correcting a deviated septum or nasal valve collapse, is generally coverable. The cosmetic component is not.
To qualify for coverage, insurers typically require documentation that conservative treatments like nasal steroid sprays and decongestants have been tried for at least four weeks without adequate relief. You’ll also need evidence of the obstruction itself, usually through nasal endoscopy or a CT scan. Insurers often ask for pre-operative photographs showing the deformity from multiple angles. If the obstruction is linked to recurrent sinus infections, a history of failed antibiotic therapy strengthens the case.
In practice, many patients end up with a partially covered procedure: insurance pays for the septoplasty and any functional work on the nasal valves, while the patient pays out of pocket for the cosmetic rhinoplasty portion. Your surgeon’s office will typically handle the pre-authorization process and can tell you early on what’s likely to be covered.