The short answers

What it treats: Deviated septum and external shapeBoth corrected in one operation and one anaesthetic.
Reported operating time: About 1 to 1.5 hoursSeptoplasty alone is roughly 30 to 45 minutes. Grafting extends this.
Anaesthesia: General anaesthesiaWith a pre-operative fitness assessment.
Time off work: At least one weekNHS trust guidance. Recovery is usually reviewed between four and eight weeks.
Trial evidence: 20.0 point SNOT-22 benefitSeptoplasty against medical management in a 378-patient randomised trial, where 9 points was the threshold for clinical importance.
Breathing improvement: Noticed as swelling subsidesAirflow often feels worse for the first one to two weeks, which is expected.

Septoplasty straightens a bent septum, the wall of cartilage and bone between the two sides of the nose, and changes nothing on the outside. Rhinoplasty reshapes the outside without correcting the deviation.

Septorhinoplasty does both. NHS guidance calls it slightly larger than septoplasty alone, because it also reshapes or repositions the nasal bones. Where airflow is the only concern, see breathing.

Does surgery actually help a deviated septum?

Yes, and randomised evidence sits behind that answer. The NAIROS multicentre randomised controlled trial, published in the BMJ in 2023, enrolled 378 adults with septal deviation and a NOSE score above 30.

Participants were randomised to septoplasty, 188 patients, or to medical management with a nasal steroid and saline spray, 190 patients.

20.0 points

Mean SNOT-22 at six months: 19.9 after septoplasty, against 39.5 with medical management. The trial pre-specified 9 points as clinically important.

NAIROS randomised controlled trial, BMJ 2023

Sprays can reduce swelling in the lining. They cannot straighten a deviation. The trial reported its harms alongside that benefit:

Seven patients, 4 per cent, were readmitted with bleeding.
Antibiotics were required by 20 patients, 12 per cent.

Scope

NAIROS studied septoplasty, the airway operation alone. It did not test a combined cosmetic and functional procedure, and should not be quoted as if it had.

How nasal obstruction is measured

Breathing is subjective, so it is measured with a validated questionnaire. The Nasal Obstruction Symptom Evaluation, or NOSE scale, has five items scored from 0, not a problem, to 4, severe problem.

The raw score is multiplied by 5 to give a total out of 100, where higher means worse. It was developed and validated in 2004, with test-retest reliability of 0.702 and internal consistency of 0.785.

A severity classification derived from 345 patients grades it:

Mild. 5 to 25.
Moderate. 30 to 50.
Severe. 55 to 75.
Extreme. 80 to 100.

A score of 30 was found to best separate patients with genuine nasal obstruction from those without. Recording it first gives a baseline.

The score does not identify the cause, which is why examination comes first. Obstruction produced by allergy or inflammation rather than by structure is not corrected by surgery.

What the operation involves

Both halves are done under one general anaesthetic. The deviated part of the septum is straightened or removed, and the dorsum, tip and width of the nasal bones are addressed as required.

An L-shaped strut of roughly 10 to 15 mm is left along the dorsal and caudal margins, so the nose keeps its central support. Septal cartilage is frequently the graft material for the reshaping half.

Where the internal nasal valve is narrow, spreader grafts are placed to open the valve angle. Narrowing a nose without supporting the airway can make breathing worse.

The approach, open or closed, depends on how much of the framework needs direct access.

A recognised complication

Septal perforation is reported after septoplasty in 0.5 to 3.1 per cent of cases in published series. Large perforations can cause crusting, bleeding, whistling and obstruction.

Recovery, and why breathing feels worse first

Nasal breathing usually feels worse for the first one to two weeks. The lining is swollen from surgery, and that swelling narrows the airway more than the deviation did, which is expected.

Week 1The external splint stays on for around a week. NHS trust guidance advises at least a week off work.
Weeks 1 to 2Breathing feels blocked, often worse than before. The congestion is swelling rather than mucus.
Around week 2Most visible bruising has resolved. Airflow starts to improve as the internal swelling settles.
Weeks 4 to 8Recovery is usually reviewed in this window under NHS trust guidance.
Months 12 to 18The external contour continues refining for twelve to eighteen months.

The day by day timeline covers each stage.

Septoplasty alone, or septorhinoplasty

The two are often used loosely as if they were the same operation. They are not.

Neither corrects obstruction produced by allergy or inflammation rather than by structure.
	Septoplasty alone	Septorhinoplasty
What it corrects	The deviated septum only, normally performed for breathing alone	The septum and the external shape, in one operation
Direct randomised evidence	Yes. NAIROS found a 20.0 point SNOT-22 advantage over medical management at six months	No. NAIROS studied the airway operation alone
If you want breathing and shape both changed	Two operations, two anaesthetics, two periods of swelling	One anaesthetic and one recovery, with septal cartilage frequently used as the graft material

Septoplasty alone is the smaller operation. Internal examination settles which of the two applies.

Before committing to a surgeon

A NOSE score and an internal examination should come before airway surgery. Ask whether both will happen, and ask before you book. Our doctors answer questions sent through the site.

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.

What is my NOSE score today, and will you record it again after surgery?
What did the internal examination find in the septum, the turbinates and the nasal valve?
If you narrow my nose, what will you do to keep the internal nasal valve open?
How much of my blockage is structural, and how much is allergy that a spray would treat?
Do you plan to use septal cartilage as graft material, and what happens if there is not enough?
Who reviews me between four and eight weeks, and where, once I have travelled home?

Sources

Every source below was opened and checked. We link to health authorities, peer-reviewed journals and professional bodies, and to nothing else.

SeptorhinoplastyENT UKBritish professional body patient information on combined functional and aesthetic surgery.
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.
Septoplasty and septorhinoplastyUniversity Hospitals Sussex NHS Foundation TrustNHS trust patient information covering the operation and its recovery.
Septal perforationStatPearls, NCBI Bookshelf (National Library of Medicine)Clinical reference on a recognised complication of septal surgery.