Dr Scott J Turner | Specialist Plastic Surgeon (FRACS) | Sydney
Most people who come in for a septoplasty consultation have been managing the same problem for years. One side of the nose that never quite opens. Nights spent mouth breathing. Congestion that does not budge no matter what nasal spray they try. And often, a long-held assumption that it is allergies, or just how their nose is. Sometimes it is. In many cases, there is a structural reason, and a deviated septum is the most common one. Septoplasty surgery in Sydney is the procedure to correct it, and for patients with a confirmed structural obstruction that has not responded adequately to conservative treatment, it is often the clearest path forward.
This guide explains what septoplasty does, when it is appropriate, how it differs from functional rhinoplasty (and when the two should be combined), Medicare eligibility, recovery, and what to expect. Dr Scott J Turner is a Fellow of the Royal Australasian College of Surgeons (FRACS, 2013), AHPRA MED0001654827, with subspecialty training in nasal surgery including septoplasty and septorhinoplasty. He consults at Bondi Junction and Manly, with surgery performed at Bondi Junction Private Hospital and Delmar Private Hospital, Dee Why.
What is a deviated septum?
The nasal septum is the wall of cartilage and bone that divides the nasal cavity into two passages. When it sits centrally, airflow is roughly equal through both nostrils. In practice, a perfectly centred septum is uncommon: most people have some degree of deviation, and most of those deviations cause no symptoms.
It becomes a problem when the deviation is significant enough to narrow one or both nasal passages and obstruct airflow. The cause is often nasal trauma. A broken nose that healed without correction is one of the more common culprits, but even a minor knock in childhood or sport can shift the septum enough to cause trouble years later. In other cases there is no obvious cause, and the deviation is part of how the nose developed.
One detail worth knowing: when the septum deviates, the body often compensates by enlarging the turbinates on the opposite side. That is why some patients describe their breathing as difficult on both sides, even when imaging shows the deviation is predominantly one-sided.
Symptoms of a deviated septum
Not every deviated septum causes symptoms. A mild deviation can sit there quietly for decades and get picked up incidentally. Where the deviation is more significant, the pattern tends to be recognisable.
| Symptom | What patients typically describe |
|---|---|
| Nasal obstruction | One or both sides of the nose feel permanently half-closed, worse at night when lying down |
| Congestion that does not respond to medication | Antihistamines and nasal corticosteroid sprays provide partial or temporary relief only |
| Mouth breathing, especially at night | Affects sleep quality; often drives snoring |
| Disrupted sleep and fatigue | Frequent waking, light sleep, dragging tiredness during the day |
| Headaches and sinus pressure | Particularly across the cheeks and forehead |
| Recurring sinus infections | Narrowed drainage pathways mean secretions pool rather than clear |
| Symptoms after a broken nose | Persistent obstruction following nasal trauma |
If several of these are familiar and medication has not provided lasting relief, it is worth having the anatomy assessed by a clinician familiar with structural nasal problems.
What is septoplasty?
Septoplasty is surgery to straighten the nasal septum. The goal is better airflow through the nasal passages, achieved by reshaping, repositioning, or removing the portions of cartilage and bone that are in the way. The procedure is performed under general anaesthetic using incisions entirely inside the nostril, so there are no external incisions, no external scarring, and no change to how the nose looks after an isolated septoplasty.
This is one of the things that surprises patients most. They come in expecting to look different afterwards. They will not, unless cosmetic rhinoplasty is being done at the same time. Septoplasty works entirely from the inside. The full surgical details, including how the procedure is performed step by step, are covered on the Septoplasty page.
Septoplasty vs functional rhinoplasty: when do you need each?
This is one of the most important distinctions in nasal surgery, and one that is often missed before the first operation. Septoplasty addresses the septum. Functional rhinoplasty addresses structural problems of the nasal sidewall and nostril rim, including nasal valve collapse. The two are anatomically different and require different surgical techniques.
| Indication | Procedure | Approach |
|---|---|---|
| Deviated septum only | Septoplasty | Reshape/reposition septum; no external work |
| Nasal valve collapse only | Functional rhinoplasty | Cartilage grafts (spreader, alar batten) to support sidewall |
| Both deviated septum and nasal valve collapse | Combined septoplasty + functional rhinoplasty | Both in one operation |
| Deviated septum plus cosmetic concerns | Septorhinoplasty | Septoplasty plus cosmetic rhinoplasty in one operation |
A patient with a deviated septum AND nasal valve collapse who has septoplasty alone may notice partial improvement, but the breathing problem will continue if the valve weakness is not also addressed. Identifying both issues before the first operation is the key to avoiding incomplete results. Clinical examination (including Cottle’s manoeuvre and NOSE Scale scoring) determines which structures are contributing to the obstruction.
Combining septoplasty with other nasal procedures
Septoplasty is frequently combined with other nasal procedures in a single operation:
- Turbinate reduction: Where inferior turbinate hypertrophy is contributing to obstruction alongside the deviated septum, turbinate reduction may be performed at the same time
- Functional rhinoplasty: Where the septum is deviated AND there are additional functional concerns such as nasal valve collapse, both are addressed in a single functional rhinoplasty operation
- Cosmetic rhinoplasty: Septoplasty combined with cosmetic rhinoplasty is septorhinoplasty, the standard approach where both functional and cosmetic concerns are present
Combining procedures has practical advantages: one anaesthetic rather than two, one recovery period, and lower total cost compared with separate operations. Where septoplasty is combined with rhinoplasty, the septal cartilage harvested during septum correction can be used as grafting material for the rhinoplasty component, which is more efficient than performing the operations separately.
Medicare and septoplasty
Septoplasty is one of the clearest Medicare-eligibility pathways in nasal surgery. Where it is performed to correct a clinically documented deviated septum causing functional nasal obstruction, Medicare contribution may apply under MBS item 41671 (septoplasty or submucous resection for a deviated septum).
For the contribution to apply:
- A GP referral confirming the functional indication is required
- Clinical documentation must demonstrate the functional need (pre-operative photographic evidence or NOSE Scale scoring)
- Conservative treatment (nasal sprays, antihistamines) must have been trialled and found inadequate
- The deviation must be clinically significant and documented at examination
The Medicare contribution applies to the surgical component. Anaesthesia fees and hospital facility fees remain out-of-pocket, with a gap payment typically expected even where the contribution applies. Where clinical criteria are met, private health insurance with appropriate hospital cover may pay the private hospital component in full, which is often the most significant financial benefit. Where septoplasty is combined with cosmetic rhinoplasty, the Medicare contribution applies only to the functional component.
For the full Medicare framework, see Will Medicare Cover My Rhinoplasty?. For the cost framework across all nose procedures, see the rhinoplasty cost guide.
Are you a suitable candidate for septoplasty?
Septoplasty may be appropriate if you have persistent nasal obstruction affecting one or both sides of the nose, documented clinical evidence of a significantly deviated septum on examination, have trialled appropriate conservative treatments without adequate long-term relief, are in good general health with no conditions that significantly increase surgical risk, are a non-smoker (or are prepared to stop smoking well before surgery), and have fully developed nasal anatomy (generally from mid-to-late teens onwards).
Where your primary concern is breathing and a structural cause has been identified, septoplasty is a straightforward functional procedure with a well-established track record. If you also have cosmetic concerns about the appearance of your nose, those can be discussed at the same consultation and a combined septorhinoplasty plan considered.
The consultation process
A GP referral is the first step for any patient considering septoplasty for a functional indication. The referral is required for Medicare eligibility and the GP’s documentation of the functional concern supports the clinical case. Consultation with Dr Turner includes a thorough assessment of nasal anatomy, review of your symptoms and their impact, and discussion of the surgical options. Nasal endoscopy and NOSE Scale scoring may be used where indicated.
Where septoplasty is performed as a standalone functional procedure, the full cosmetic surgery regulatory requirements do not apply. Where cosmetic rhinoplasty is being combined, Medical Board and AHPRA requirements apply to that component, including a minimum of two consultations, a psychological assessment where indicated by validated screening, a 7-day cooling-off period for adult patients before formal surgical consent, and a 3-month cooling-off period for any patient under 18 years of age.
Septoplasty recovery: what to expect
Recovery from septoplasty is generally less involved than recovery from cosmetic rhinoplasty because the external nose has not been operated on, so there is no external splint and typically less visible bruising around the eyes. A summary timeline:
| Stage | What to expect |
|---|---|
| Week 1 | Silicone splints in, nose feels completely blocked; mouth breathing is normal |
| Splint removal (approx week 1) | Splints removed at the post-operative appointment |
| Weeks 2-4 | Internal swelling reduces, breathing continues to improve; desk work resumed |
| Weeks 4-6 | Light activity; avoid exercise and contact sport |
| Months 2-3 | Full functional benefit typically apparent as residual internal swelling resolves |
Where turbinate reduction or rhinoplasty was combined, the recovery follows the longer combined timeline. For the full recovery framework across nose surgery, see the week-by-week rhinoplasty recovery timeline.
Risks and complications
Septoplasty is generally a low-risk procedure, but all surgery carries risk. Specific risks include bleeding during or after surgery, infection, adverse reaction to general anaesthesia, septal perforation (a hole in the septum, uncommon, usually small, may cause crusting or whistling sounds during breathing), persistent or incomplete correction of nasal obstruction, adhesions (scar tissue forming inside the nose), altered sense of smell (usually temporary), and the possibility of revision surgery. Dr Turner discusses the risks specific to your anatomy and proposed approach at consultation.
Frequently asked questions
What is septoplasty and what does it involve?
Septoplasty is surgery to correct a deviated nasal septum, the wall of cartilage and bone that divides the nasal cavity. Where the septum is significantly deviated, it narrows one or both nasal passages and restricts airflow, causing chronic nasal obstruction, mouth breathing, and disrupted sleep. The procedure is performed under general anaesthetic using incisions entirely inside the nose, so there are no external incisions and no change to the external appearance of the nose. Deviated portions of the septum are reshaped, repositioned, or removed to create a straighter internal wall and improve airflow. Recovery from an isolated septoplasty is typically two to three weeks for most normal activities, with full functional improvement at approximately three months.
Is septoplasty covered by Medicare in Australia?
Yes, where clinical criteria are met. Septoplasty performed to correct a documented, functionally significant deviated septum may attract a Medicare contribution under MBS item 41671. A GP referral is required, and clinical documentation including photographic evidence or NOSE Scale scoring must support the claim. Conservative treatments must have been trialled and found inadequate. The contribution covers the surgical component only: anaesthesia and hospital fees remain out-of-pocket, with a gap payment typically expected. Private health insurance with appropriate hospital cover may pay the private hospital component where Medicare criteria are met. Dr Turner’s team advises on likely eligibility at consultation.
How long does septoplasty recovery take?
Most patients return to desk-based work within one to two weeks. Silicone splints are removed at approximately one week. Strenuous activity and contact sport should be avoided for four to six weeks. Full functional improvement in nasal airflow typically occurs at two to three months as internal swelling completely resolves. Where septoplasty is combined with cosmetic rhinoplasty, the recovery follows the longer rhinoplasty timeline, with the final cosmetic result at approximately 12 months.
What is the difference between septoplasty and rhinoplasty?
Septoplasty corrects the internal nasal septum to improve breathing. It works entirely inside the nose, leaves no external scarring, and does not change how the nose looks from the outside. Rhinoplasty addresses the external shape, size, and proportions of the nose, primarily for cosmetic purposes, though it may also address functional concerns. Septorhinoplasty combines both in a single operation, the recommended approach where a patient has both a functionally significant deviated septum and cosmetic concerns. Combining them is more efficient than two separate operations and preserves septal cartilage as grafting material for the rhinoplasty component.
Can a deviated septum come back after septoplasty?
A true recurrence of the original deviation after well-performed septoplasty is uncommon. However, the septum may shift slightly during healing, and in a small number of cases, residual or recurrent deviation can cause ongoing or returning symptoms. This is more likely where the original deviation was severe or extended to the bony septum as well as the cartilaginous portion. Approximately five to ten per cent of septoplasty patients may require a revision procedure at some stage. Dr Turner discusses the likelihood of revision in your specific case at consultation, based on the nature and extent of your deviation.
Schedule a consultation with Dr Turner
If you have persistent nasal obstruction that has not responded to medical management, a clinical assessment can identify whether a deviated septum is contributing and whether septoplasty is the appropriate next step. Dr Scott Turner consults at Bondi Junction and Manly. Surgery is performed at Bondi Junction Private Hospital and Delmar Private Hospital, Dee Why.
To schedule a consultation, contact our team.
Phone: 1300 437 758 Email: [email protected] Bondi Junction: 39 Grosvenor Street, Bondi Junction NSW Manly: Suite 504, Level 5, 39 East Esplanade, Manly NSW
Standalone functional septoplasty follows a different regulatory pathway from cosmetic surgery. Where cosmetic rhinoplasty is being combined, two consultations are required before scheduling, in line with Medical Board and AHPRA requirements.
