Deviated Septum Surgery (Septoplasty): Procedure, Healing – and why Dr. Klaus Hebold does not use nasal packings

A deviated septum is not uncommon – for many people, it is not perfectly centered without 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 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 should realistically expect.

First of all, because it is the most common concern before the procedure: Dr. Hebold does not use nasal packings. Why this is possible and what happens instead is explained in a dedicated section below.

Note beforehand: Nasal surgery at the FORUM Klinik is exclusively in the hands of Dr. med. Klaus Hebold – and he operates exclusively on women's noses. We do not offer nasal surgeries for men, not even as a purely functional procedure. This is a conscious decision of specialization and not a question of individual cases. If you are a man suffering from obstructed nasal breathing: the information in this article remains professionally unchanged; for the treatment itself, an ENT clinic or another nasal surgery specialist is the right address.

What is a Septoplasty?

The nasal septum separates the two nasal cavities. It consists of cartilage in the front and thin bone in the back. If it is deviated, 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 septoplasty, the septum is straightened. The access is 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 with chronically obstructed breathing. If only the septum is straightened, breathing remains restricted in such cases.

We offer the entire range of nasal septum correction – including extracorporeal correction for particularly severe cases, where the septum is straightened outside the body and replanted. We also treat septal perforations, i.e., holes in the nasal septum.

Important to distinguish: Septoplasty does not change the external shape of the nose. It is a functional procedure. Anyone wishing to both breathe better and change the shape of the nose requires a combined operation – septorhinoplasty, which is a nose correction with a functional component.

When is surgery sensible?

Not every deviation needs to be operated on. The decisive factor is not the imaging finding, but the level of suffering. Factors in favor of a procedure include:

• permanently obstructed nasal breathing, on one or both sides

• mouth breathing and dry throat, especially at night

• snoring or restless sleep due to 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 dependency

At this point, we also deliberately state the opposite: In our experience, deviations of the nasal septum and enlarged nasal turbinates are diagnosed too frequently rather than too rarely. Not every deviation affects function. This is exactly what explains surgeries that ultimately achieved nothing. We therefore check before every procedure whether the anatomy really explains the symptoms.

And 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 a procedure. Cartilage and bone do not align themselves through sprays, patches, or exercises. Anyone who promises you this is selling you something.

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

Decongestant nasal drops and sprays are explicitly not a permanent solution. With prolonged use, the mucous membrane becomes accustomed to them and swells more severely upon discontinuation than before. There is a specific medical term for this addiction: privinism. In extreme cases, the mucous membrane regresses and you get practically no air without drops. A cortisone-containing nasal spray and hypertonic nasal rinses (see below) are suitable for weaning off.

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, this will not change in a year either.

The Procedure

Preparation. No blood-thinning agents 14 days before the operation.

The Operation. Septoplasty is performed under general anesthesia and usually takes 45 to 60 minutes – if the external nose is corrected at the same time (septorhinoplasty), it takes about two hours. Depending on the extent, the procedure is performed as an outpatient or inpatient, then usually with an overnight stay.

As soon as you are asleep, the surgeon injects the mucous membrane with medication that reduces blood flow for about three hours and locally anesthetizes the nerves. This allows for practically blood-free work, and the anesthesia itself can remain superficial and gentle. An operated nose usually causes little to no pain afterwards – this surprises most patients.

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 reattached. Finally, the nose is stabilized – and that is exactly the part that is talked about too rarely beforehand.

Nasal Packings? Not with us.

Hardly any question is asked of us so often before nose surgery. The answer is clear: We do not use nasal packings.

For context, because you will read otherwise elsewhere: Packings are an established and fundamentally functioning procedure. They stuff the nose, keep the mucous membrane in position, and stop bleeding, and many clinics work with them routinely. However, the price for this is high. As long as a packing is in place, nasal breathing is completely blocked: you breathe through the mouth, the throat becomes dry, and sleep is restless. And the removal of the packing after one to three days is the moment from which the horror stories originate that patients tell each other.

Dr. Hebold consistently avoids nasal packings during procedures on the nasal septum. The prerequisite for this is an operating technique that already leaves stable conditions at the end of the procedure – then nothing needs to be stuffed from the inside anymore.

Instead, soft silicone splints with ventilation tubes are used, so-called Doyle splints in the soft version. These thin splints are attached to both sides of the septum. They maintain the new position, prevent the mucosal sheets from sticking together – and allow you to breathe through your nose from the very first hour after surgery thanks to the integrated tubes.

By the way, this also applies if we only need posterior parts of the nasal septum as a cartilage donor for a rhinoplasty. If work is done on the septum, aftercare is done with silicone splints. Nasal packings are not used.

What you will notice during this time: Your sense of smell may be restricted or completely absent as long as the splints are in place – the air is directed straight to the throat and does not reach the olfactory mucosa. This returns completely. It is important in the first few days to keep the tubes clear: sniff up consistently and use sea salt spray. If that does not succeed, it is not a tragedy – the nose will just feel tighter until the splints are removed.

And regarding removal: Many are afraid of this because they have heard those stories about packings. That is not necessary here. Silicone splints are not packings. Silicone does not stick to the mucous membrane, even after weeks. In experienced, gentle hands, the removal does not hurt and comes out softly. The splints remain for 1 to 7 days, depending on the extent of the procedure.

An external splint over the bridge of the nose is not needed for a pure septoplasty – it is only added if work was done on the external nose at the same time.

The Healing Process Day by Day

Day 1 to 3. The silicone splints are in place, and you get air through the nose from the start via the ventilation tubes. Keep your head elevated, drink plenty of fluids. Keep the tubes clear by sniffing up and using sea salt spray. Slight blood oozing is normal, as is a feeling of pressure in the face and behind the eyes. Smell is reduced.

Day 1 to 7. The splints are removed – exactly when depends on what was done. Breathing is often not immediately free afterwards: the mucous membrane is swollen and crusts form. This phase leads to the most uncertainty. It is the planned course, not a sign that something did not work.

Week 1 to 2. The swelling goes down noticeably, and breathing becomes freer day by day. Nasal care is now part of the daily routine – it loosens crusts and significantly accelerates healing.

Week 2 to 4. Crusting decreases. Most people can resume their normal daily activities.

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.

Nasal Care Afterwards

This is the part that is in your own hands – and it makes a bigger difference than most assume.

• Sea salt spray as often as is comfortable.

• Ointment, for example Bepanthen, once or twice daily.

• Nasal gel only if the nose becomes blocked in the first week – and please no longer than one week, otherwise dependency begins.

• Sniffing up is good, blowing the nose is bad. Please sniff up secretions and swallow or dab away.

Nasal rinses often work wonders for dryness and crusting. Hypertonic means about 35 grams of salt to one liter of clean water – as salty as seawater. Afterwards, the nose runs slightly and is moist, and that is exactly what the mucous membrane needs. If it runs too much, rinse with isotonic solution: 9 grams to one liter, as salty as tears. A few grams do not matter. Commercial nasal douches work, but it can also be done without tools – wash hands, form a cup with one hand, pour in solution, gently sniff up and let it run out again.

When can I sleep normally again?

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

Because nasal breathing is possible from the start via the ventilation tubes, most sleep significantly better in the first few nights than they had feared.

How long are you written off sick?

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, significantly longer – here, 3 to 4 weeks are realistic.

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

• Do not blow your nose. Sniff up secretions and swallow or dab away.

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

• Sport and sauna can be started carefully again after 4 to 6 weeks; contact sports and anything with a risk of falling significantly later.

• No nicotine. Smoking significantly delays mucosal healing.

• Glasses wearers: In the first 6 weeks, there should be no pressure on the bridge of the nose. If this cannot be managed, we can fashion a splint for you with which you can wear your glasses. Please ask us about this.

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 a septoplasty cost?

Here lies a significant difference to aesthetic nose correction.

Statutory insured: In the case of a proven functional impairment, septoplasty is a service covered by health insurance. We settle directly with the statutory health insurance companies and are authorized to assess the finding ourselves. You do not need to submit an application for this.

Privately insured: Please obtain approval from your insurance company before the operation with the cost estimate for the medical portion.

Important for combined procedures: If a medical problem is corrected and an aesthetic service is provided in one surgery, the insurance does not cover the aesthetic part proportionally. That remains entirely a self-pay service. Anesthesia costs are also billed separately. So, it is not the case that an aesthetic wish becomes cheaper just because a medical finding is also present. You will receive a detailed cost plan after the first consultation – in writing, and before the procedure.

Possible Risks

Septoplasty is considered a low-complication procedure, but like any surgery, it is not risk-free. Postoperative bleeding and infections are absolute rarities. Also possible are persistent crusting and dryness, as well as temporary loss of smell or sensation, mostly in the incisors and the tip of the nose. Rarely, a perforation of the nasal septum, adhesions between the septum and turbinate, or a change in the external shape of the nose occur.

In a portion of cases, breathing remains restricted despite a technically correct operation – for example, if an unrecognized allergic or functional component exists. This is also why we carefully clarify the causes beforehand.

We will discuss your individual risk profile during the consultation; additionally, you will receive an informed consent form in advance.

Consultation at the FORUM Klinik Cologne

The entire nasal surgery of the FORUM Klinik is handled by Dr. med. Klaus Hebold, who has dedicated himself exclusively to this field since July 2025 and was recognized in the research-based physician recommendation list of STERN for rhinoplasty in the years 2023 to 2025. As mentioned above, he treats female patients exclusively; we do not offer nasal surgeries for men.

If you have been breathing poorly through your nose for years, open your mouth at night, or can no longer get by without nasal spray: We will look at the finding and tell you honestly whether surgery will change anything in your case – and whether function and shape can be sensibly combined. If we come to the conclusion that a procedure will not benefit you, we will tell you so.

Please feel free to arrange a personal consultation.

Frequently Asked Questions

Do you also operate on men?

No. Dr. Hebold has specialized in nasal surgery in women and operates exclusively on female patients – this also applies to purely functional procedures such as septoplasty. For men with obstructed nasal breathing, an ENT clinic or another nasal surgery specialist is the right contact point.

Will I get nasal packings?

No. Dr. Hebold fundamentally does not use nasal packings. For procedures on the nasal septum, soft silicone splints with ventilation tubes (Doyle splints) are used, which allow you to breathe through your nose directly after the operation.

Does removing the silicone splints hurt?

No. The fear of this almost always comes from stories about packings – and silicone splints are something completely different. Silicone does not stick to the mucous membrane, even after weeks. The splints come out gently.

How long do the splints stay in the nose?

Depending on the extent of the procedure, 1 to 7 days.

How long does a septoplasty take?

Usually 45 to 60 minutes, depending on the extent and whether the nasal turbinates are treated as well. In the case of a combined septorhinoplasty, about two hours. The stay in the clinic lasts significantly longer than the operation itself.

Can I smell after the surgery?

As long as the silicone splints are in place, the sense of smell is reduced or completely absent because the air is directed straight to the throat via the tubes and does not reach the olfactory mucosa. It returns after removal.

Why is the nose not yet completely clear after the splints are removed?

Because the mucous membrane is swollen and crusts form. This is the planned course and not a sign that the procedure did not work. Consistent nasal care significantly shortens this phase; the final result is achieved over several weeks.

Will my nose shape change due to the surgery?

Septoplasty is designed not to change the external shape. In rare cases, minor changes can still occur, for example, if a lot of supporting cartilage had to be removed. This belongs in the informed consent discussion.

Can I combine a septoplasty with a rhinoplasty?

Yes. This combined operation is called septorhinoplasty and is performed in one session. You can find more about this on our nose correction page. The functional portion may be reimbursable, the aesthetic portion remains entirely a self-pay service.

What happens if I start exercising too early?

The risk of postoperative 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 release after the check-up.

Will the deviation return?

After healing is complete, the straightened septum generally remains stable. A new trauma – such as a blow to the nose – can shift it again.