What is Septoplasty?
The nasal septum is the wall of cartilage and bone that divides the nose into two passages. When it is crooked or shifted to one side (a "deviated septum"), it can block airflow through one or both nostrils.
Many people notice this during the day, but the effect on breathing is often worse during sleep. Think of drinking a supersized Coke through a thin paper straw. You have to pull hard, and the straw starts to flatten. Now picture bubble tea through a wide plastic straw, where even the boba come up with little effort. When the nose is obstructed, the body works harder to pull air through a narrower space. This can contribute to snoring and sleep apnea.
Septoplasty for patients
Septoplasty straightens the deviated portions of the septum to improve airflow. In practice, "straightening" means removing the pieces of cartilage and bone that block the nasal passage, where it is safe to do so. A frame of cartilage along the top and front of the septum is always kept to support the nose. The surgery is done entirely through the nostrils. There are no incisions on the outside of the nose, and septoplasty is not meant to change how the nose looks.
Dr. Liu often combines septoplasty with reduction of the inferior turbinates (the tissue ridges inside the nose) to achieve the best result. For patients whose narrow palate contributes to nasal obstruction, maxillary expansion (DOME) may also be discussed.
The goal is to restore comfortable nasal breathing, especially during sleep.
Before surgery
- Stop aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), fish oil, vitamin E and other supplements that thin the blood 7 days before surgery.
- If a doctor prescribed a blood thinner, do not stop it on your own. We will coordinate with that doctor.
- Follow the fasting instructions from the anesthesia team.
- Most patients go home the same day. Arrange for an adult to drive you home and stay with you the first night.
After surgery
- Stuffiness and light bloody drainage are normal for the first few days. Change the gauze under your nose as needed.
- Sleep with your head raised on two or three pillows for the first week.
- Use saline spray in each nostril several times a day to keep the inside of the nose moist.
- Do not blow your nose for one week. If you need to sneeze, sneeze with your mouth open.
- Avoid heavy lifting, bending over and hard exercise for two weeks.
- If soft splints were placed, they come out at your first visit, about one week after surgery.
- Most people return to desk work in about one week.
- If you use CPAP, ask us before you restart it.
Call us right away if
- Bleeding does not slow after 15 minutes of gentle pressure. Lean forward and pinch the soft part of the nose.
- You have a fever above 101°F (38.3°C).
- Pain or swelling keeps getting worse instead of better.
- You notice clear, watery drainage from one side of the nose, or any change in your vision.
For an emergency, call 911.
Septoplasty is a common and well tolerated operation. As with any surgery, there are risks. We review them with you before surgery, since your own risks depend on your anatomy and health.
- Bleeding
- A nosebleed after surgery is usually minor. Rarely, heavier bleeding needs packing or a return to the operating room.
- Infection
- Uncommon, and treated with antibiotics when it happens.
- Persistent blockage
- The nose may still feel blocked if the turbinates, the nasal valve or a narrow nasal floor also play a part. Further treatment, including DOME, may be considered.
- Septal perforation
- A small hole can form in the septum. It may cause crusting or a whistling sound and sometimes needs repair.
- Septal hematoma
- A collection of blood in the septum. Uncommon, and drained promptly if it occurs.
- Scar bands
- Bands of scar can form inside the nose and can be released if they block airflow.
- Numbness
- The upper front teeth, gums or nose tip may feel numb. This usually improves over weeks to months.
- Change in smell
- Usually temporary.
- Change in nose shape
- Rare. The supporting frame of the septum is preserved to protect the shape of the nose.
- Spinal fluid leak
- Very rare.
- Anesthesia
- Risks of general anesthesia are reviewed with you by the anesthesia team.
Septoplasty video for patients
Septoplasty, explained for patients
A short video for patients about septoplasty. Press play to watch it here, or open it on YouTube.
Septoplasty for referring physicians
The internal nasal valve (INV) is comprised of the septum, inferior turbinates, caudal edge of the upper lateral cartilages, and the bony nasal floor. The INV can account for up to 50% of total upper airway resistance. In patients with sleep-disordered breathing, even modest nasal obstruction increases the negative inspiratory pressure that promotes pharyngeal collapse during sleep.
Septoplasty addresses deviations of the quadrangular cartilage, vomer, and maxillary crest components that contribute to INV narrowing. Critical septal support structures, particularly the dorsal and caudal L-strut, are preserved to maintain nasal integrity.
In our practice, septoplasty is frequently performed in conjunction with inferior turbinate reduction (radiofrequency ablation with outfracture) and, when indicated, nasal valve repair or piriformplasty. For patients with transverse maxillary hypoplasia contributing to a narrow nasal floor, distraction osteogenesis maxillary expansion (DOME) offers an adjunctive approach to widen the INV at its skeletal foundation.
Correction of nasal obstruction has been shown to improve sleep quality and enhance adherence to positive airway pressure therapy. It also serves as a foundational intervention within the updated Stanford Sleep Surgery Algorithm, which integrates site-directed nasal, palatal, tongue base, neurostimulation, and skeletal procedures based on individual patient phenotyping.
Related Research by Dr. Liu
Hidden septal deviation is common in sleep apnea
In 274 patients seen at the Stanford sleep surgery clinic, about 1 in 5 had a deviation at the back of the septum that a routine look inside the nose would miss. A nasal endoscope found something that changed the treatment plan in about 1 in 4 (26.6%). Endoscopy is recommended for anyone with nasal blockage or trouble tolerating CPAP, and it is part of every evaluation in the Stanford sleep surgery protocol.
When septoplasty is not enough, the cause may be the width of the nasal floor (the roof of the palate)
In 89 adults treated for nasal obstruction, those who stayed blocked after septoplasty, turbinate, valve or sinus surgery had a narrower upper jaw (18.4 vs 20.3 mm) and a higher arched palate (8.0 vs 6.6 mm). Soft tissue surgery does not widen bone. These patients may be candidates for maxillary expansion.
DOME after septoplasty improves nasal breathing
In a feasibility study of 32 patients who were still blocked after septoplasty and had a narrow, high-arched palate, DOME cut nasal obstruction (NOSE) scores by more than half, from 13.6 to 5.2, and widened the nasal floor from 22.4 to 28.1 mm. There were no major complications.