Rhinoplasty changes the external shape of the nose. Septoplasty straightens the septum inside the nose to improve breathing, without intending to change appearance. Septorhinoplasty combines both, reshaping the nose while correcting the septum. Which one is appropriate depends on whether your concern is appearance, breathing, or both.
Three operations with different goals
The nose has two jobs that surgeons consider together: how it looks and how it works. The external framework of bone and cartilage gives the nose its shape, while the internal structures, especially the septum and the nasal valves, control airflow. Because these parts are connected, work on one can affect the other. A septum that is bent near the front, for example, can pull the tip to one side, while removing too much support during cosmetic surgery can narrow the airway. Understanding the aim of each operation helps you ask the right questions.
Side by side
- Rhinoplasty: aims to alter appearance, such as reducing a hump, refining the tip or narrowing the bridge. Usually a private cosmetic procedure.
- Septoplasty: aims to improve breathing by straightening or removing bent parts of the septum. External shape is not intended to change. Performed through incisions inside the nose, usually by ENT surgeons.
- Septorhinoplasty: aims to improve both appearance and function in one operation, and is often chosen when a crooked nose and a deviated septum occur together.
- Anaesthetic: all three are normally performed under general anaesthetic.
- Visible bruising: common after rhinoplasty and septorhinoplasty, particularly when the nasal bones are moved; usually minimal after septoplasty alone.
- Splint: an external splint is usually worn for about a week after rhinoplasty and septorhinoplasty; internal splints may be used after septoplasty.
Why a septum becomes deviated
Most people have a septum that is slightly off-centre, and this is normal. A more marked deviation can be present from birth or follow an injury, sometimes one that happened in childhood and was forgotten. Symptoms include blockage on one or both sides, snoring, mouth breathing and difficulty using nasal sprays. A deviation towards the front of the nose tends to cause more obstruction than one further back. For more detail, see the guide to the deviated septum.
Recovery compared
After septoplasty alone, the nose usually feels blocked for one to two weeks while the lining heals, but external swelling is limited, and many people are back at desk work within a week or so. After rhinoplasty or septorhinoplasty, bruising around the eyes and swelling of the nose are more noticeable, typically improving over two weeks, with fine swelling settling over twelve months or more. Septorhinoplasty can feel a little more congested initially because both the inside and outside of the nose have been operated on. In all cases, contact sports are avoided for around six weeks.
Risks to consider
Shared risks include bleeding, infection, a reaction to the anaesthetic and blood clots. Specific to septal surgery are a hole in the septum (perforation), persistent blockage and altered sense of smell. Rhinoplasty and septorhinoplasty carry additional risks of asymmetry, irregularities, an unsatisfactory shape and the possibility of revision. Removing septal cartilage must leave enough support to prevent the bridge from sinking.
Which is right for you?
If your only concern is breathing and you are happy with how your nose looks, a septoplasty through an ENT surgeon is usually the appropriate route, and your GP can advise on referral. If you want to change the shape of your nose and breathe normally, rhinoplasty is designed for appearance. If you have both a cosmetic concern and a structural breathing problem, septorhinoplasty avoids two separate operations and allows cartilage from the septum to be used as graft material. Mr Nassab will assess both the outside and inside of the nose to recommend an approach.
Cost
Rhinoplasty costs from £8,950. Septorhinoplasty is quoted at consultation, as the extent of septal work varies. The £150 consultation fee is separate. Cosmetic nasal surgery is only for adults aged 18 and over.
Frequently Asked Questions
Can rhinoplasty and septoplasty be done together?
Yes. Combining them is called septorhinoplasty, and it is common when a person wants a cosmetic change and has a septal breathing problem.
Does septoplasty change the shape of the nose?
It is not designed to, although straightening the front of the septum can make a slightly crooked tip look more central.
Is septorhinoplasty more painful than rhinoplasty?
Discomfort is usually similar and well controlled with simple pain relief, though the nose may feel more congested at first.
Is septoplasty available on the NHS?
Septoplasty for significant breathing problems may be available through NHS ENT services, depending on local criteria. See rhinoplasty on the NHS.
