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Septoplasty recovery: what happens in the weeks after
Septoplasty alone normally leaves no cast and, per ENT UK, no black eyes are expected, and it is still not a small recovery, because the nose is blocked afterwards by swelling and by whatever is placed inside it. This post gives the timings a British professional body and one NHS trust give their own patients, explains packing and internal splints, and puts the things that went wrong next to the number of people they happened to.
The short answers
- Time off work
- Two weeksENT UK patient advice for septal surgery. Guidance for the ordinary case, not a measurement of anybody.
- Breathing clearer
- Up to three months, per ENT UKENT UK, for the nose to settle and breathing to be clearer. One NHS trust says the blockage may take a few weeks to feel better.
- Readmitted with bleeding
- 7 of 1744 per cent of operated participants in the NAIROS trial at 17 NHS clinics, reported at six months. None needed a second operation.
- Antibiotics for infection
- 20 of 17212 per cent, on the denominator the trial report gives for that item, in the same trial arm. Each harm in the trial carries its own denominator.
Most pages we found on this subject offer a day-by-day timeline with no source behind any day. This one has fewer numbers, a source for each, and says which are advice and which were measured.
Why this is not a rhinoplasty recovery
A septoplasty straightens the wall between the nasal passages through incisions inside the nose. Nothing is done to the bridge or tip, so there is normally no external cast, and ENT UK does not expect black eyes or a change in the shape of the nose. Most are day cases.
What it leaves is a blocked nose: the lining swells, crusts collect, and anything placed inside to support the septum occupies the airway. When the septum is straightened as part of a combined operation, the recovery is the septorhinoplasty one, with a cast and bruising; the rhinoplasty day by day timeline applies instead.
The timings, and who says so
Both sources below are patient leaflets: what a professional body and one hospital trust tell their patients. They are advice, nothing here measured how long any nose stayed blocked, and the two disagree on nose blowing.
| What the leaflet says | Source | |
|---|---|---|
| Packing, where used | Out within hours or the next day; dissolving dressings stay | ENT UK |
| Internal splints, where used | Out in clinic at seven to ten days | ENT UK |
| Blowing the nose | None for at least two days after getting home, then gently; the trust says a week | ENT UK; NHS trust |
| Saline rinsing, where advised | From the day after surgery | NHS trust |
| Work | Two weeks off | ENT UK |
| Contact sports | Not for four weeks | NHS trust |
| Flying | Not for 14 days | ENT UK |
| Breathing clearer | Up to three months | ENT UK |
On packing
A 2013 meta-analysis, which its authors call the first on the question, pooled 16 studies published up to 2010, 11 of them randomised, and found routine packing after septoplasty gave no benefit against bleeding, haematoma, septal perforation, adhesions or residual deviation, and was associated with more infections; its authors concluded routine packing is not warranted. It is an older, mixed evidence base, so the direction of the finding is better supported than any figure in it. Whether anything goes inside your nose is a question for the surgeon.
What went wrong, and in how many
The fullest count we found comes from the NAIROS trial, which randomised 378 adults at 17 NHS clinics to septoplasty or six months of steroid and saline spray. Its main result is covered elsewhere on this site; the harms column, reported at six months, belongs here.
- Readmitted to hospital with bleeding: 7 of 174 operated participants, 4 per cent; none needed a further operation.
- Infection needing antibiotics: 20 of 172, 12 per cent.
- Numbness of the upper teeth: 18 of 171, 11 per cent. Reduced sense of smell: 19 of 171, also 11 per cent.
- A change in the appearance of the nose: 17 of 171, 10 per cent.
- Septal perforation in six people, 3 per cent, and adhesions in seven, 4 per cent, at the six and twelve month visits.
What those numbers describe
One trial, one health system, surgeons the authors describe as experienced, and patients who all had a deviation a specialist could see, more than 80 per cent of them with severe or extreme symptoms. Each item carries the denominator the trial report gives it. The figures describe that group at those timepoints, not one person, and not any theatre list outside the trial.
On shape, ENT UK says it does not expect a change, then lists a slight change among the complications and says it can be common; one in ten trial participants reported one.
Still blocked weeks or months later
A nose blocked at two weeks is inside what both leaflets describe. ENT UK gives up to three months for breathing to be clearer, and the trial measured its result at six months, so neither offers an earlier date for judging breathing. ENT UK also says the septum cannot always be completely straightened, or can bend again, in one out of ten cases, a leaflet figure with no denominator.
Blockage past that window has several possible causes: a septum that has not stayed straight, an adhesion, swollen turbinates, or a nasal valve that was never the septum's problem. The breathing guide covers how those are told apart, and why a plan made without examination can aim at the wrong structure.
What is not ordinary
In the first two weeks, ENT UK asks patients to contact the unit or their GP for a continuing fever of 38°C or more, feeling unwell and not eating or drinking, or pain the painkillers do not control. The trust leaflet gives bleeding first aid: pinch the soft part of the nose, lean forward, apply ice, and go to the emergency department if it has not stopped after 30 minutes. The warning signs page covers the rest.
For anyone who travelled, splint removal at seven to ten days and the fortnight for reporting a fever can both fall around the flight home. The before you travel and recovery preparation checklists have room for who does which.
Questions to ask a surgeon
Take these to a consultation. The consultation checklist is built to be printed and written on, and our doctors will answer questions sent through the site before you travel.
- Will anything be packed or splinted inside my nose, on which day does it come out, and who removes it?
- When can I blow my nose, and do you want me rinsing with saline from the day after?
- If I am flying home, who do I contact about bleeding or a fever, and where do I go if it does not stop?
- What was my nasal obstruction score before the operation, so there is something to compare at three and six months?
- If my nose is still blocked at three months, how will you tell whether it is the septum, the turbinates or the valve?
- Could the shape of my nose change, even though this is a breathing operation?
Sources
Every source below was opened and checked. We link to health authorities, peer-reviewed journals and professional bodies, and to nothing else.
- Clinical effectiveness of septoplasty versus medical management for nasal airways obstruction: multicentre, open label, randomised controlled trialThe BMJ, via PubMedThe NAIROS trial. Randomised evidence that septoplasty outperforms medical management in adults with obstruction associated with a deviated septum.
- Scientific summary: effectiveness of septoplasty compared to medical management in adults with obstruction associated with a deviated nasal septum, the NAIROS randomised controlled trialNIHR Journals Library, via NCBI Bookshelf (National Library of Medicine)The funder's own report of the trial, including what each arm actually received and the difference the trial had judged meaningful before it began.
- Discussion: effectiveness of septoplasty compared to medical management in adults with obstruction associated with a deviated nasal septum, the NAIROS randomised controlled trialNIHR Journals Library, via NCBI Bookshelf (National Library of Medicine)The trial authors' own account of what their result does not cover, which is the part of a trial that almost never gets quoted.
- Is nasal packing necessary after septoplasty? A meta-analysisInternational Forum of Allergy and Rhinology, via PubMedThe first meta-analysis on routine nasal packing after septoplasty, by its authors' account: 16 studies to 2010, no benefit found and more infections.
- Septal surgeryENT UKBritish professional body patient information on septal surgery alone, with its timings for packing, splints, nose blowing, work and clearer breathing.
- Septoplasty aftercare advice (ENT)Gloucestershire Hospitals NHS Foundation TrustNHS trust aftercare sheet for septoplasty: nose blowing, saline rinsing, contact sports, the blocked nose and bleeding first aid.