A deviated septum is not uncommon – in many people it is not exactly centered without it ever being noticed. It only becomes a problem when nasal breathing is permanently obstructed: poor sleep, a constantly dry mouth in the morning, recurring sinus infections, the feeling of never being able to take a proper deep breath.

When nasal sprays and cortisone-based sprays are no longer sufficient, the question of surgery arises. This article explains what happens during the procedure, how healing actually progresses, and what you can realistically expect.

What is a Septoplasty?

The nasal septum divides the two nasal cavities. It consists of cartilage at the front and thin bone at the back. If it is crooked, one nasal passage becomes narrower than the other. The airflow is disrupted, the mucous membrane dries out, and the nose feels congested, even though it objectively is not.

During a septoplasty, the septum is straightened. Access is gained inside the nose – there is no visible scar on the face. Deviated cartilage and bone parts are straightened, weakened, or removed and reinserted in a corrected position.

Frequently, the nasal turbinates are also reduced in size. These structures on the lateral nasal wall often enlarge permanently when breathing is chronically obstructed. If only the septum is straightened, breathing remains restricted in such cases.

Important distinction: A septoplasty does not change the outer shape of the nose. It is a functional procedure. Anyone wishing to both breathe better and change the shape of their nose requires a combined surgery – a septorhinoplasty, which is a rhinoplasty with a functional component.

When is surgery sensible?

Not every deviation needs to be operated on. The decisive factor is not the image findings, but the level of suffering. Reasons for a procedure include:

• permanently obstructed nasal breathing, on one or both sides

• mouth breathing and a dry throat, especially at night

• snoring or restless sleep caused by nasal breathing

• recurring sinus infections

• frequent nosebleeds on a protruding edge

• reduced sense of smell due to obstructed airflow

• decongestant nasal sprays that you need for weeks – with the risk of addiction

Before surgery is performed, allergic causes should be ruled out. An untreated house dust or pollen allergy can cause the same symptoms – and surgery will not solve them.

Is there an alternative to surgery?

This question is frequently asked, and the honest answer is twofold.

The deviation itself cannot be corrected without surgery. Cartilage and bone do not straighten through sprays, plasters, or exercises. Anyone who promises you this is selling you something.

The symptoms can often be alleviated. Cortisone-containing nasal sprays reduce mucosal swelling and often provide enough air in cases of mild deviation. Nasal rinses with saline solution help with crusting and dryness. Consistent allergy treatment can make the decisive difference. Nasal strips and nasal dilators widen the outer nasal wing – they only work if the narrowness is located there and not at the septum.

Decongestant nasal sprays are explicitly not a long-term solution. With prolonged use, the mucous membrane becomes accustomed to them and swells more severely upon discontinuation than before.

The decision rule: If conservative measures are sufficient to get through the day and night symptom-free, surgery is not necessary. If they are not sufficient, nothing will change in a year either.

The Procedure

A septoplasty is usually performed under general anesthesia and typically lasts 45 to 60 minutes. Depending on the scope, it is performed as an outpatient procedure or with a short hospital stay.

All incisions are made inside the nose. The mucous membrane is detached from the cartilage, the deviated parts are corrected, and the mucous membrane is then put back in place. Finally, the nose is stabilized – and that is exactly the part that is rarely discussed beforehand.

Tampons and Splints

Tampons (nasal packing) keep the mucous membrane in position and stop bleeding. Modern versions are coated with a film or designed as small inflatable balloons so that they do not stick to the mucous membrane when removed. They usually remain in place for 1 to 3 days.

Silicone splints are thin plates attached to both sides of the septum. They prevent the mucosal layers from sticking together and stabilize the new position. They remain in place longer than the tampons, usually 7 to 10 days.

The days with tampons are the most uncomfortable part of the entire process. Nasal breathing is completely blocked, you breathe through your mouth, your throat gets dry, and sleep is restless. This is not a sign that something is going wrong – it is the planned state.

Regarding removal: Removing the tampons is briefly uncomfortable, often accompanied by a strong feeling of pressure. It only takes seconds. Removing the splints is significantly less uncomfortable than most people fear. Many describe the moment afterward as the first free deep breath in years.

The Healing Process Day by Day

Day 1 to 3. Tampons in the nose, exclusively mouth breathing. Keep your head elevated, drink plenty of fluids, keep your throat moist. Light oozing of blood is normal. A feeling of pressure in the face and behind the eyes is to be expected.

Day 3 to 7. Tampons are removed. Breathing is often still not free afterward – the mucous membrane is swollen and crusts form. This phase leads to the most uncertainty: many expect immediate improvement and instead experience a still-congested nose.

Day 7 to 14. The splints are removed. Now breathing usually improves noticeably. Nasal rinses and care sprays are part of the daily routine from here on – they loosen crusts and significantly accelerate healing.

Week 2 to 4. Swelling decreases significantly. Crusting subsides. Most people can resume their normal daily routine.

Week 4 to 12. The mucous membrane regenerates completely. The final breathing result is achieved during this time.

After 3 to 6 months. The nose has completely stabilized.

When can I sleep normally again?

During the first one to two weeks, you should sleep with an elevated upper body and on your back. This reduces swelling and prevents nighttime nosebleeds. Sleeping on your side is usually possible again after two to three weeks, and sleeping on your stomach later – as it exerts direct pressure on the nose.

As long as the tampons are in place, sleep is restless for most. This subsides significantly after removal.

How long will I be on sick leave?

This is the most frequently asked question before the procedure.

For predominantly sedentary work, 1 to 2 weeks are common. For physically demanding work, dust exposure, or heavy lifting, it is significantly longer – here 3 to 4 weeks are realistic.

Regardless of the profession, the following applies during the first few weeks:

• Do not blow your nose. Sniff secretions up and swallow, or dab them off.

• No heavy lifting, no straining, no bending over with your head lowered.

• No sports in the first 2 to 3 weeks; contact sports and anything with a risk of falling for significantly longer.

• No sauna, no hot baths, no solariums – heat promotes swelling and post-operative bleeding.

• No nicotine. Smoking significantly delays mucosal healing.

• Glasses wearers: In the first few weeks, there should be no pressure on the bridge of the nose. Mention this – there are practical solutions.

The most common mistake is returning to full activity too early because the nose feels good after the splints are removed. The mucous membrane is far from fully healed at this point.

How much does nasal septum surgery cost?

This is where a significant difference lies compared to aesthetic rhinoplasty.

In the case of a proven functional impairment, health insurance usually covers the procedure. The prerequisite is a documented medical finding – obstructed nasal breathing, appropriate examination, and, if necessary, measurement of airway resistance.

If the outer shape is changed at the same time, the procedure is split: the functional portion remains covered by insurance, while the aesthetic portion is a self-pay service. This split should be clarified in writing before the procedure – not afterward.

As a pure self-pay service, septoplasty is billed according to the German Fee Schedule for Physicians (GOÄ). You can find an overview in our cost overview; after the consultation, you will receive a written cost plan.

Possible Risks

Septoplasty is considered low-risk, but like any surgery, it is not without risk. Possible complications include post-operative bleeding, infections, persistent crusting and dryness, as well as temporary loss of smell or sensation, usually in the front teeth and the tip of the nose. Rarely, a perforation of the nasal septum, adhesions between the septum and turbinate, or a change in the outer shape of the nose may occur. In some cases, breathing remains restricted despite a technically correct operation – for instance, if there is an unrecognized allergic component.

We will discuss your individual risk profile during the consultation.

Consultation at the FORUM Klinik

If you have had difficulty breathing through your nose for years, keep your mouth open at night, or can no longer manage without nasal spray: we will assess the findings and tell you honestly whether surgery will make a difference in your case – and whether function and form can be sensibly combined. Please feel free to arrange a personal consultation.

Frequently Asked Questions

How long does nasal septum surgery take?

Usually 45 to 60 minutes, depending on the scope and whether the nasal turbinates are also treated. The stay in the clinic lasts significantly longer than the surgery itself.

Why is the nose still congested after surgery?

Because the mucous membrane is swollen and crusts are forming. This is the normal course of healing and not a sign that the procedure did not work. Noticeable improvement usually occurs after the splints are removed, with the final result emerging over several weeks.

Does removing the splints hurt?

Significantly less than most people expect. Pulling the tampons in the days beforehand is the more uncomfortable moment – and it only takes seconds.

Will my nose shape change due to the surgery?

Septoplasty is designed not to change the outer shape of the nose. In rare cases, minor changes may still occur, for example, if a lot of supporting cartilage had to be removed. This is part of the informational consultation.

Can I combine nasal septum surgery with a rhinoplasty?

Yes. This combined surgery is called septorhinoplasty and is performed in a single session. You can find more details on our page about rhinoplasty. The functional part may be eligible for reimbursement, while the aesthetic part remains a self-pay service.

What happens if I start exercising again too early?

The risk of post-operative bleeding increases significantly, and mucosal healing is delayed. In the event of a fall or blow to the nose that is not yet stabilized, the result can be compromised. Adhere to the clearance given after your follow-up check.

Does the deviation return?

Once healing is complete, the straightened septum usually remains stable. A new trauma – such as a blow to the nose – can displace it again.