What Is Septorhinoplasty? Combining Cosmetic and Functional Nose Surgery

Dr Scott J Turner | Specialist Plastic Surgeon (FRACS) | Sydney

A lot of patients come to rhinoplasty consultations with two concerns sitting alongside each other: they don’t like how their nose looks, and they’ve had breathing problems for years. The assumption is often that these need to be treated as separate decisions, possibly separate operations. In most cases they don’t. Septorhinoplasty addresses both in a single procedure, and for patients with both concerns, it’s generally the recommended approach.

Dr Scott J Turner is a Fellow of the Royal Australasian College of Surgeons (FRACS) with specific training in rhinoplasty, septoplasty, and combined nasal surgery. He consults at his Sydney clinics in Bondi Junction and Manly, with surgery performed at Bondi Junction Private Hospital and Delmar Private Hospital, Dee Why.

What Is Septorhinoplasty?

Septorhinoplasty combines two distinct procedures in one operation:

Rhinoplasty addresses the external shape, size, and structure of the nose — the profile, the tip, the bridge, the overall proportions.

Septoplasty corrects the nasal septum — the internal wall of cartilage and bone that divides the nasal cavity — where it is deviated enough to obstruct airflow and cause breathing problems.

Combined into a single operation, septorhinoplasty addresses both simultaneously. One anaesthetic, one recovery period, one set of surgical costs. The result addresses how the nose looks and how it works.

Why Combine Them?

This is the question worth spending time on, because the answer isn’t just convenience.

The septal cartilage problem. Septal cartilage is the most important grafting material in rhinoplasty. It’s used for tip support, structural reinforcement, spreader grafts for the nasal valve, and dorsal augmentation. When a standalone septoplasty is performed first, a significant portion of this cartilage is removed or reshaped to straighten the septum. That material is then unavailable when rhinoplasty follows later. The rhinoplasty surgeon is working with a depleted toolkit, which may require sourcing cartilage from the ear or rib — adding complexity and cost to what should have been a more straightforward operation.

Performing both together preserves the septal cartilage. The septoplasty straightens the septum, and the harvested cartilage goes directly into the rhinoplasty component where it’s needed most.

One recovery instead of two. Rhinoplasty recovery is not trivial. Nasal splint for a week, visible bruising for two to three weeks, activity restrictions for six weeks, final result at 12 months. Doing this twice — once for septoplasty, once for rhinoplasty — means going through that process twice. Most patients with both concerns, once they understand this, prefer to do it once.

Better surgical planning. When both are planned together, the aesthetic and functional goals inform each other. The septal correction can be designed with the rhinoplasty in mind, and the rhinoplasty can account for the structural changes from the functional work. Doing them sequentially means the second surgeon is working around what the first one did.

What Does Septorhinoplasty Actually Involve?

The procedure is performed under general anaesthetic using an open rhinoplasty approach — a small incision across the columella, the strip of tissue between the nostrils. This gives direct access to both the internal septum and the external nasal framework simultaneously.

The functional component addresses whatever is causing the breathing obstruction. Most commonly this is septal deviation — the septum is exposed, and the deviated cartilage and bone is reshaped, repositioned, or removed to create a straighter internal wall. Where nasal valve issues are also present, spreader grafts or batten grafts are placed to reinforce and widen the valve.

The cosmetic component addresses whatever external changes are planned — dorsal hump reduction, tip refinement, nasal bone narrowing, or a combination, depending on the patient’s anatomy and goals.

Harvested septal cartilage from the functional component is set aside and used as grafting material for the cosmetic component where needed.

Operating time typically ranges from two to three hours depending on the complexity of both components.

Septorhinoplasty vs Septoplasty vs Rhinoplasty

Patients researching nasal surgery encounter all three terms and the differences aren’t always clear. Here’s a straightforward breakdown:

Septoplasty alone — corrects a deviated septum to improve breathing. Internal procedure only. No external incisions, no change to the shape of the nose. The nose looks exactly the same afterwards.

Rhinoplasty alone — addresses the external shape of the nose for cosmetic purposes. May be cosmetic only, or may include some functional work, but is primarily about appearance.

Septorhinoplasty — combines both. Addresses internal septal deviation causing breathing obstruction AND external cosmetic concerns in a single operation.

For a full explanation of each procedure separately, see septoplasty, cosmetic rhinoplasty, and functional rhinoplasty.

Medicare and Septorhinoplasty

This is one of the most common questions in septorhinoplasty consultations, and the answer is nuanced.

The functional component may attract a Medicare rebate. Where the septoplasty component meets clinical criteria — documented nasal obstruction, a GP referral, photographic or NOSE Scale evidence — the relevant item numbers may apply. The most commonly used is item 41671 (septoplasty) and where external functional work is involved, 45641 (total functional rhinoplasty) may apply.

The cosmetic component is not covered. Medicare does not rebate cosmetic rhinoplasty regardless of how significant the cosmetic concern is.

In a combined operation, the rebate applies to the functional component only. This is still meaningful. Where private health insurance criteria are also met, the hospital fees may be covered in full by the insurer, which is often the most financially significant benefit.

The practical effect: a patient having septorhinoplasty where the functional criteria are met is in a better financial position than a patient having cosmetic rhinoplasty alone, because the functional component attracts rebates that offset part of the overall cost.

For a full explanation of item numbers, documentation requirements, and what remains out-of-pocket, see the Medicare rhinoplasty guide.

AHPRA Regulatory Requirements

The cosmetic component of septorhinoplasty is subject to the full AHPRA cosmetic surgery requirements effective 1 July 2023:

• A referral from your GP or a specialist physician
• A minimum of two consultations with Dr Turner before surgery is booked
• A psychological evaluation to confirm suitability
• A mandatory cooling-off period before formal consent is given

The functional component alone follows a different regulatory pathway. Where both are being addressed, the cosmetic requirements apply to the cosmetic component. Dr Turner’s team will clarify which requirements apply to your specific situation at consultation.

Are You a Suitable Candidate?

Septorhinoplasty may be appropriate if you:

• Have specific cosmetic concerns about the appearance of your nose
• Also have a documented functional problem — a deviated septum, nasal valve issue, or breathing obstruction — that has not responded adequately to conservative treatment
• Are in good general health with no conditions significantly increasing surgical risk
• Are a non-smoker, or can cease smoking well before surgery
• Have realistic expectations about both the cosmetic and functional outcomes, including an understanding that the cosmetic result takes 12 months to fully develop

Where you have cosmetic concerns but no functional problem, cosmetic rhinoplasty is the appropriate discussion. Where you have functional concerns only and no interest in cosmetic changes, septoplasty alone is the more appropriate procedure.

Recovery

Septorhinoplasty recovery follows the rhinoplasty timeline rather than the septoplasty timeline, because the external nose has been operated on.

• Week 1 — external nasal splint worn, internal splints where used, nasal congestion expected, head elevation required
• Splint removal at approximately one week — breathing improvement typically noticeable immediately
• Weeks 2 to 3 — visible bruising resolves, most patients comfortable returning to public settings
• Weeks 4 to 6 — strenuous exercise and contact sport avoided
• Months 3 to 6 — significant cosmetic refinement as deeper swelling settles
• 12 months — final cosmetic result. Functional improvement is typically apparent much earlier, at two to three months

For a full week-by-week breakdown, see the rhinoplasty recovery guide.

Cost

Septorhinoplasty is priced based on the components involved. The functional component falls within the functional rhinoplasty range; the cosmetic component is added to that.

Where Medicare rebates apply to the functional component and private health insurance covers the hospital fees, the effective out-of-pocket cost is lower than the figures above. A formal itemised quote with expected rebates and gap payments is provided after consultation. For full pricing detail, see the rhinoplasty cost guide.

Frequently Asked Questions

What is septorhinoplasty and how is it different from rhinoplasty?

Septorhinoplasty combines rhinoplasty, which addresses the external shape of the nose, with septoplasty, which corrects the internal nasal septum to improve breathing. Standard rhinoplasty addresses cosmetic concerns only and does not correct a deviated septum. Septorhinoplasty is recommended where a patient has both cosmetic concerns about the nose’s appearance and a functional breathing problem caused by a deviated septum or related structural issue. The Medicare rebate may apply to the functional component where clinical criteria are met.

Why is it better to combine septoplasty and rhinoplasty rather than doing them separately?

The primary reason is septal cartilage preservation. Septal cartilage is the most important grafting material in rhinoplasty, used for structural support, tip refinement, and valve repair. Performing septoplasty first removes a significant portion of this cartilage before it is needed for rhinoplasty. Combining both preserves that resource. Additional benefits include one anaesthetic, one recovery period, and better intraoperative planning when both concerns are addressed together.

Does septorhinoplasty change the external appearance of the nose?

Yes. Because septorhinoplasty includes rhinoplasty, it does involve changes to the external shape of the nose as part of the cosmetic component. Isolated septoplasty, by contrast, makes no external changes. Where only breathing correction is needed and no cosmetic changes are desired, standalone septoplasty is the appropriate procedure and leaves the nose looking exactly as it did before surgery.

Is septorhinoplasty covered by Medicare?

The functional component of septorhinoplasty may attract a Medicare rebate where clinical criteria are met, including documented nasal obstruction, a GP referral, and photographic or NOSE Scale evidence. The cosmetic component is not covered. In a combined procedure, the rebate applies only to the functional component. Where private health insurance criteria are also met, the hospital fees may be covered in full by the insurer. A formal quote including expected rebates and gap payments is provided after consultation.

How long does septorhinoplasty recovery take?

Recovery follows the rhinoplasty timeline. An external nasal splint is worn for approximately one week. Visible bruising typically resolves over two to three weeks. Most patients return to public settings and desk-based work within two to three weeks. Strenuous exercise and contact sport are avoided for six weeks. Functional improvement in breathing is typically noticeable from splint removal at one week, with full improvement at two to three months. The cosmetic result takes 12 months to fully develop as swelling resolves.

Consult with Dr Scott J Turner

Dr Turner consults for septorhinoplasty in Sydney at Bondi Junction and Manly. He also sees patients in Brisbane, Canberra, Newcastle, and the Gold Coast. Surgery is performed in Sydney at Bondi Junction Private Hospital and Delmar Private Hospital, Dee Why.

Contact the practice to arrange a consultation, or read more about Dr Turner’s background and training.