Dr Scott J Turner | Specialist Plastic Surgeon (FRACS) | Sydney
Some patients consider nose surgery for how it looks. Others consider it because they can’t breathe properly through one or both sides, snore badly, or wake up with a dry mouth from breathing through it all night. The two groups overlap more often than patients expect. About a third of patients who present for “cosmetic” rhinoplasty turn out to have a functional issue contributing to their concern. A similar fraction of patients presenting with breathing issues also have external nasal asymmetry from old trauma or congenital deformity.
This article focuses on the functional side specifically: deviated septum, nasal valve collapse, turbinate hypertrophy, and the procedures that address them. Septoplasty, functional rhinoplasty, septorhinoplasty, and turbinate reduction are distinct procedures with different clinical indications, different Medicare implications, and different recovery profiles. The consultation is where the surgical plan gets matched to the actual structural cause of the obstruction.
For the full Canberra rhinoplasty overview, including cosmetic rhinoplasty, functional rhinoplasty, open and closed approaches, recovery, and consultation logistics, start with the Rhinoplasty Canberra page. This article focuses specifically on breathing, deviated septum, and functional nasal obstruction. Dr Scott J Turner is a Specialist Plastic Surgeon (FRACS) consulting at the Campbell clinic in Canberra and at Sydney clinics in Bondi Junction and Manly.
Researching nasal breathing surgery in Canberra? This article is the medical/functional spoke. For the consultation process specifically (what happens at the assessment, what to bring), see Rhinoplasty in Canberra: What the Consultation Process Involves. For the full procedure overview including cosmetic and functional, the Rhinoplasty Canberra page is the starting point.
What causes nasal obstruction
Worth saying up front: not every blocked nose is surgical.
Allergy, rhinitis, sinus disease, medication overuse (particularly long-term decongestant nasal spray use), and inflammatory conditions can all contribute to nasal obstruction. These are medically managed first. Functional rhinoplasty is considered when structural factors are present and the clinical picture supports surgical correction, not as a first-line response to any blocked nose.
The structural causes commonly addressed by functional surgery:
- Deviated septum (the cartilage and bone wall dividing the two nasal passages is bent or displaced)
- Nasal valve collapse (the narrowest internal part of the airway is too weak to stay open during inhalation)
- Turbinate hypertrophy (the soft tissue structures inside the nose are enlarged and reduce airflow)
- External nasal framework problems (the outer support of the nose has deviated or weakened, often from trauma)
The consultation assesses each of these specifically rather than assuming any single cause.
Deviated septum
The septum is the central cartilage and bone wall between the two nasal passages. A deviated septum is a septum that’s bent, displaced, or has a spur (bony or cartilaginous projection) that obstructs airflow.
A deviated septum doesn’t always cause symptoms. Many people have minor septal deviation visible on examination but breathe normally. Surgical correction is considered when the deviation is contributing to documented breathing problems, not when it’s an incidental finding.
Septoplasty (Latin: “septum” + “plasty”) is the procedure that addresses septal deviation. It involves straightening, repositioning, or selectively removing parts of the deviated septum to restore a more open airway. The work is internal, with no external incisions or cosmetic external changes.
Nasal valve collapse
The nasal valve is the narrowest internal part of the nasal airway, located approximately where the upper lateral cartilages meet the septum. It’s the region where most airflow resistance occurs during normal breathing.
Nasal valve collapse means the valve narrows or closes excessively during inhalation, either because the supporting cartilage is weak or because the valve angle is too acute. It’s a common cause of breathing problems that doesn’t show up on simple visual examination and requires specific assessment.
This matters because septoplasty or turbinate reduction alone may not fully improve breathing if the valve problem is missed. Published literature describes patients who undergo septoplasty or inferior turbinate reduction without significant symptom relief when nasal valve obstruction wasn’t recognised pre-operatively. Treatment depends on the cause: spreader grafts (cartilage grafts placed to support the valve), batten grafts (grafts placed to support weak lateral cartilage), or other techniques depending on anatomy.
Turbinate hypertrophy
The turbinates are soft tissue structures inside each nostril that warm and humidify air. The inferior turbinates can become enlarged (hypertrophic), reducing airflow and contributing to obstruction.
Turbinate reduction reduces turbinate volume while preserving function. Several techniques exist (radiofrequency reduction, submucous resection, outfracture, partial turbinectomy), with the appropriate technique depending on the cause and degree of hypertrophy.
Turbinate reduction may be performed with septoplasty in selected patients, but timing depends on the overall surgical plan. Where rhinoplasty is also being performed, the turbinate contribution may be assessed after the nose has healed and the new structural dimensions are stable, rather than treating the turbinates simultaneously.
Septoplasty vs functional rhinoplasty vs septorhinoplasty
Side-by-side:
| Procedure | Main purpose | External nose changed? | Medicare relevance |
|---|---|---|---|
| Septoplasty | Straighten or modify the septum to improve airflow | No cosmetic external reshaping | Item 41671 may apply where septal surgery is clinically indicated |
| Functional rhinoplasty | Address structural airway problems such as valve collapse or external framework issues | May involve external framework support | Rhinoplasty items may apply where MBS criteria are met |
| Septorhinoplasty | Combine septal/airway work with external reshaping | Yes, if cosmetic or structural reshaping is included | Functional component may be eligible; cosmetic component is not Medicare-covered |
| Turbinate reduction | Reduce enlarged turbinates while preserving function | No cosmetic external reshaping | Separate airway item pathways may apply depending on procedure and criteria |
The procedures aren’t interchangeable. The right choice depends on what’s actually causing the obstruction. Many patients need a combination of two or more in the same operation.
Medicare and functional rhinoplasty
This is where wording matters because the MBS item structure has caused confusion online.
Medicare doesn’t cover cosmetic rhinoplasty performed for appearance alone. Medicare benefits may apply only to functional or reconstructive components where the relevant MBS item criteria are met and clinical need is documented.
Septoplasty item 41671 relates to septal surgery, including septoplasty, septal reconstruction, septectomy, closure of septal perforation, or other modifications of the septum, subject to item conditions and exclusions. This is the septal surgery item and has its own criteria, distinct from the rhinoplasty items below.
Rhinoplasty items 45632 to 45644 and 45650 apply only where the indication is airway obstruction with a self-reported NOSE Scale score greater than 45, or significant acquired, congenital, or developmental deformity, with photographic and NOSE Scale evidence demonstrating clinical need documented in the patient notes.
Item table:
| Item / item group | What it broadly relates to | Key documentation point |
|---|---|---|
| 41671 | Septal surgery / septoplasty | Clinical indication and item conditions apply |
| 45632 | Partial rhinoplasty involving lateral / alar cartilages | NOSE Scale >45 or qualifying deformity plus required documentation |
| 45635 | Partial rhinoplasty involving bony vault | NOSE Scale >45 or qualifying deformity plus required documentation |
| 45641 | Total rhinoplasty involving bony and cartilaginous elements | NOSE Scale >45 or qualifying deformity plus required documentation |
| 45644 / 45650 | More complex total / revision rhinoplasty categories | NOSE Scale >45 or qualifying deformity plus required documentation |
Eligibility can’t be confirmed from symptoms alone. It depends on GP referral, clinical assessment, documentation, item criteria, and whether the planned procedure meets the relevant MBS requirements. The consultation determines whether the case meets functional criteria; it doesn’t pre-determine the answer. The Rhinoplasty Canberra page covers the overall surgical assessment pathway including both functional and cosmetic components.
What the consultation needs to document
For Medicare claims involving functional rhinoplasty or septoplasty, documentation matters. The consultation typically captures:
- GP referral and breathing symptom history
- Duration of obstruction (recent vs long-standing)
- Whether obstruction is one-sided or both sides
- Previous trauma or nasal surgery
- Previous non-surgical treatment (sprays, allergy management, saline rinses)
- Internal nasal examination findings
- Septal position and deviation pattern
- Turbinate contribution to obstruction
- Nasal valve assessment
- NOSE Scale score where relevant
- Clinical photographs where relevant
- Whether cosmetic and functional components are separate or combined
This documentation supports both clinical decision-making and any subsequent Medicare claim where MBS criteria are being assessed. For broader consultation preparation, see the Plastic Surgery Consultation Checklist.
Cost considerations
Functional rhinoplasty and septorhinoplasty pricing varies depending on whether the procedure is septoplasty-only, functional rhinoplasty, combined septorhinoplasty, revision surgery, the need for grafting, hospital cover, anaesthesia, and Medicare and private health eligibility.
A written quote is provided after consultation once the functional and cosmetic components, if any, have been separated and the surgical plan has been finalised. Quotes are individualised; published ranges online tend to be misleading because the variables that drive cost aren’t visible until the assessment is complete.
The practice doesn’t endorse, partner with, or recommend any specific loan providers or BNPL services.
Recovery: septoplasty-only vs functional rhinoplasty vs combined septorhinoplasty
Recovery differs significantly between procedures.
Septoplasty-only recovery is typically mostly internal. There may be internal splints for a week, limited external swelling, and no external splint or cast. Most patients return to desk-based work within 1 to 2 weeks. Breathing may feel worse during the first week because internal swelling and any splints can temporarily worsen obstruction. This is normal and resolves as swelling settles.
Functional rhinoplasty (without external cosmetic component) recovery is intermediate. There may be external splint or cast for approximately 7 days, more external swelling than septoplasty-only, and more bruising depending on the extent of framework work.
Combined septorhinoplasty recovery is more involved. External swelling, bruising, splinting, and longer settling of nasal shape are all expected. Most patients spend 7 to 10 days in Sydney post-operatively before returning to Canberra. The cast or splint is typically removed at around 7 days. Visible swelling may persist for weeks, with finer swelling continuing to settle over several months.
Breathing improvement may not be immediate in any of these procedures because swelling and splints can temporarily worsen obstruction in the first week. This is expected. The eventual airway improvement, where surgical correction matches the underlying cause, becomes apparent over weeks rather than days.
Consultation pathway under AHPRA cosmetic surgery guidelines
Where cosmetic rhinoplasty is part of the plan (combined septorhinoplasty), current Medical Board and AHPRA cosmetic surgery guidelines (July 2023) apply.
Current requirements where cosmetic components are involved:
- GP or eligible specialist referral before cosmetic surgery consultation
- At least two pre-operative consultations with the operating surgeon, with at least one in person
- Consent forms can’t be requested at the first consultation. Informed consent is finalised at the second
- Cooling-off period of at least seven days after the second consultation and informed consent before surgery can be booked or a deposit paid
- Psychological screening for body dysmorphic disorder and other relevant factors using a validated tool
For purely functional rhinoplasty or septoplasty without cosmetic components, the standard referral and clinical assessment pathway applies. The cosmetic surgery pathway requirements relate specifically to the cosmetic component where present.
For Canberra patients: consultation, Sydney surgery, recovery logistics
Consultations occur at the Campbell clinic. Surgery is performed at accredited private hospital facilities in Sydney. Sydney stay duration depends on which procedure is performed: septoplasty-only patients may return to Canberra within several days, while combined septorhinoplasty patients typically stay 7 to 10 days for early review and cast removal.
Subsequent reviews are planned through the Campbell clinic where appropriate, with Sydney review arranged when needed based on procedure complexity and healing. For travel and accommodation logistics, see Travelling from Canberra to Sydney for Plastic Surgery.
Where to go from here
For the full procedure overview including cosmetic and functional rhinoplasty, visit the Rhinoplasty Canberra page.
For the consultation process specifically (what happens at the assessment, what to bring, first vs second consultation), see Rhinoplasty in Canberra: What the Consultation Process Involves.
For travel and accommodation logistics, see Travelling from Canberra to Sydney for Plastic Surgery.
To arrange a consultation, contact the practice online or call 1300 437 758. A GP referral is required before any cosmetic surgery consultation and is also important for Medicare documentation where functional pathology is identified. Consultations at the Campbell clinic are held on Fridays by appointment.
Canberra Clinic: G24/6 Provan Street, Campbell ACT 2612 Email: [email protected] Consultations: Fridays by appointment
Frequently asked questions
Is septoplasty the same as functional rhinoplasty?
No. Septoplasty addresses the septum inside the nose. Functional rhinoplasty addresses structural airway problems that may involve the septum, nasal valves, turbinates, or external nasal framework. Some patients need septoplasty alone, while others need broader functional rhinoplasty or combined septorhinoplasty where structural and cosmetic concerns coexist. The distinction depends on what’s actually causing the breathing problem.
Will Medicare cover deviated septum surgery?
Septoplasty item 41671 may apply where septal surgery is clinically indicated and item conditions are met. This is the septal surgery item and has its own criteria. Broader rhinoplasty items (45632 to 45644 and 45650) are separate and require airway obstruction with a self-reported NOSE Scale score greater than 45, or significant acquired, congenital, or developmental deformity, plus photographic and NOSE Scale documentation. Eligibility can’t be confirmed before assessment.
What is the NOSE Scale?
The NOSE Scale (Nasal Obstruction Symptom Evaluation) is a validated patient-reported measure of nasal obstruction symptoms. It scores nasal obstruction from 0 to 100 and is used in clinical assessment and MBS documentation for rhinoplasty items where airway obstruction is the indication. A NOSE Scale score greater than 45 is one of the criteria for MBS rhinoplasty items 45632 to 45644 and 45650, with photographic and NOSE Scale documentation required in the patient notes.
Why might septoplasty alone not fix my breathing?
Septoplasty corrects septal deviation, but breathing problems may also involve nasal valve collapse, inferior turbinate hypertrophy, or other nasal airway factors. Nasal valve obstruction is a recognised reason patients may continue to report obstruction after septoplasty if it wasn’t identified before surgery. This is why the consultation includes specific assessment of the septum, turbinates, and nasal valve rather than focusing on one structure alone.
Can functional rhinoplasty and cosmetic rhinoplasty be combined?
Yes. When both functional and cosmetic concerns are present, septorhinoplasty may address both in the same operation. The functional component may attract a Medicare rebate where MBS criteria are met; the cosmetic component is not Medicare-covered. The consultation needs to separate and document each component clearly. Combined procedures follow the cosmetic surgery pathway (two consultations, cooling-off, etc.) for the cosmetic component.
