Septorhinoplasty - Combined Rhinoplasty And Septoplasty

The inside and the outside of the nose. One operation, one recovery.

If one side of your nose has been blocked for years and you also dislike the hump, the twist or the drooping tip, septorhinoplasty corrects the septum inside and reshapes the outside in a single operation under one general anesthetic. In a 2019 Lancet trial, adults whose deviated septum was straightened breathed and felt clearly better at twelve months than those treated with sprays alone, and the benefit held at two years. This page explains what the combined operation changes, who it suits, what the week in Istanbul looks like, how the result settles over the following year, and what to send for a free review.

Why combine the two operations

Septorhinoplasty is a combined rhinoplasty and septoplasty.

Septoplasty straightens the septum, the wall of cartilage and thin bone that divides the nose into two airways. Rhinoplasty changes the shape of the nose you see, its bridge, width and tip. Doing both in one sitting makes sense because the two parts of the nose are one structure. A septum that bends to the left pulls the tip and the lower bridge with it, so a nose that looks crooked from the front is frequently a nose that breathes badly on one side, and straightening only the outside would leave the airway blocked while straightening only the inside can leave the twist visible.

A practical reason matters too.

Cartilage taken from the septum during the septoplasty is the material surgeons prefer for reshaping the outside, and it is right there in the same operation. One anesthetic, one splint, one week of bruising.

Does straightening the septum help?

For years nobody could say for certain, because no randomized trial existed. That changed in 2019. Eighteen Dutch hospitals randomly assigned 203 adults with a deviated septum and a blocked nose either to septoplasty, with or without trimming of the turbinates, or to nasal sprays and watchful waiting. At twelve months the surgery group scored 72.2 on the Glasgow Health Status Inventory against 63.9 in the medication group, and the advantage was still there at 24 months. A meta-analysis of the three randomized trials now available, covering 721 patients, confirmed better nasal obstruction scores after surgery at six and twelve months. The combined operation shows the same pattern in patient-reported scores. In 490 functional septorhinoplasties at the University of Michigan between 2019 and 2024, the NOSE score, a 100-point questionnaire on blocked breathing where a lower number is better, fell on average by 32 to 45 points, on a scale where a score of 55 or more marks severe obstruction.

Surgery is the right step only after sprays have been tried properly. A steroid spray used daily for at least a month, correctly aimed, settles swelling of the lining, and if breathing is still blocked after that, the obstruction is structural.

Swollen turbinates, the ridges on the side walls of the nose, add to the blockage in many patients. Surgeons reduce them in the same operation.

Who it suits, and who should wait

Adults with a blocked side of the nose that sprays have not fixed, and who also want a change to the shape, are the usual candidates. People whose nose was broken years ago and healed crooked, inside and out, fit the same pattern. Revision patients, whose earlier rhinoplasty left them unable to breathe or with a collapsed bridge or tip, form a third group, and their operation is longer and nearly always needs cartilage from the ear or rib.

Several situations call for waiting.

• Teenagers whose face is still growing, which for most girls means before 16 and for most boys before 17 or 18, unless breathing is severely affected
• A fresh fracture, which is set within the first two weeks and reshaped months later once the bones have healed
• Smokers, until they have stopped for at least four weeks, because nicotine starves the thin skin over the tip of blood
• Anyone on blood thinners, aspirin, fish oil or high-dose vitamin E, until their doctor has a plan to pause them safely

And a surgeon will spend real time on what you hope the nose will look like, because a result that matches the photograph you brought may still disappoint if the hope behind the photograph was larger than the nose.

Some noses cannot become a particular shape. Very thick skin hides fine detail at the tip, and very thin skin shows every edge of the cartilage beneath it.

Inside the operating room

Under general anesthesia, a first septorhinoplasty takes two and a half to four hours, and a revision takes longer. Surgeons choose between an open approach, with a small cut across the skin between the nostrils that leaves a fine line few people can see after a year, and a closed approach, with every cut inside the nostrils. Open gives the surgeon a direct view of the tip cartilages and suits noses that need significant tip work or a revision. Closed suits noses that need mainly a hump removed and a septum straightened. Both reach the septum the same way.

The septum and the shape

Septal work comes first. Through a cut inside one nostril, the lining is lifted off both sides of the septum like a sleeve, the bent cartilage and bone are removed or straightened, and an L-shaped strut of at least one centimeter along the bridge and the front edge stays behind to hold the nose up. The surgeon sets the removed cartilage aside for grafts and lays the lining back, holding it with fine dissolving stitches or soft silicone sheets on each side. With the airway corrected, the surgeon turns to the shape. Shaving bone and cartilage lowers a hump, small controlled cuts called osteotomies narrow or straighten the nasal bones, and stitches and grafts reshape the tip. Spreader grafts, thin strips of septal cartilage placed along the bridge, widen the internal valve, the narrowest point of the airway, and are one of the main reasons the combined operation improves breathing more than septoplasty alone in people whose valve collapses when they breathe in.

An external splint goes on at the end. Most surgeons now avoid thick packing, so you breathe partly through the nose from the first evening.

Two additions in the operating room reduce discomfort. A meta-analysis of five trials found that a sphenopalatine ganglion block, a local anesthetic injected at the back of the nose, reduced bleeding during surgery and pain for 24 hours afterward, and a 2019 review of 37 studies supported local anesthetic, anti-inflammatory drugs and gabapentin as alternatives to strong opioid painkillers.

How the three operations compare

Septoplasty, rhinoplasty and the combined operation differ in what they change, how long they take and how the first week feels.

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Where the cartilage comes from

Surgeons reach first for septal cartilage in a primary operation. Straight and firm, it comes from the same field and leaves no second scar. Revisions frequently lack enough of it, because an earlier surgeon took it, and then the ear or the rib supplies the material. Curved, soft ear cartilage suits the tip and the nostril rims and comes out through a cut hidden behind the ear. Strong, plentiful rib cartilage rebuilds a collapsed bridge or a whole framework, taken through a cut of three to four centimeters under the breast or chest fold.

Rib cartilage brings more risk.

A twenty-year Dutch series of 2,606 septoplasties and septorhinoplasties put numbers on it, and among the 1,774 patients with complete records the overall complication rate was 15.2 percent, most of it minor. Using the patient's own rib raised the odds of a complication elevenfold, and donated rib cartilage about sixfold. Infection struck 19.2 percent of grafts from the patient's own rib against 3.6 percent of donated ones, while visible resorption, where the graft shrinks over time, affected 32.1 percent of donated rib against 3.8 percent of the patient's own. Follow-up averaged 47.5 months for the 1,384 patients whose follow-up was recorded, long enough to catch late resorption. Those figures come mostly from the hardest revision cases, and they argue for settling in advance whether rib will be needed and which kind.

Complications in numbers

Serious problems after a first septorhinoplasty are uncommon. Across the three randomized septoplasty trials, rates ranged from 0.31 percent for revision to 4.12 percent for bleeding and infection. In the Lancet trial, one of 102 surgical patients developed a septal abscess and two developed a small hole in the septum, complications that are rare but known. Nosebleeds in the first week are mostly light oozing that stops with head elevation and pressure, and the heavier bleeding that needs a doctor happens in a small minority and is managed with packing. Antibiotics treat infection, and a collection of blood or pus between the septal linings is drained promptly, because left alone it can soften the cartilage. A septal perforation, a hole in the septum, may cause whistling or crusting and sometimes needs repair. Smell can change, in both directions.

A 2026 meta-analysis of 102 studies and 16,072 patients found new loss of smell after nasal surgery in 2.7 percent, yet the share of patients with a poor sense of smell fell overall from 22.2 percent before surgery to 14.5 percent after, because better airflow carries scent to the top of the nose.

Patients ask about revision more than any other risk. Second operations carry a higher chance of it than first ones, and most revisions are small corrections to the tip or a residual bump, made a year or more later once the swelling has fully settled. Some minor asymmetries can also be helped early. In a 2026 randomized trial of 128 adults, soft internal nasal dilators worn after septorhinoplasty produced clearly better nostril symmetry at twelve months, with a mean score of 0.46 against 1.40 on a five-point scale, and no device complications.

The first year, stage by stage

Days one to three

Patients go home or to the hotel the morning after surgery.

Expect the nose to feel blocked, as with a heavy cold, and a small gauze pad under the nostrils catches oozing. Tablets control the moderate pain well. Swelling and bruising around the eyes peak on the second or third day, and sleeping with the head raised on two pillows and cold compresses on the cheeks keep them down.

Days five to seven

Internal silicone sheets, if used, come out around day five to seven. The external splint and any skin stitches come off on day seven, and the surgeon checks the shape, the septum and the wound. Breathing improves the moment the sheets are out. The lining stays swollen for some weeks. Saline rinses twice a day clear crusts.

Weeks two to six

By the second week the bruising has faded. Desk work and social life resume, but glasses should not rest on the bridge for six weeks, so for that time they are taped to the forehead or swapped for contact lenses. Running, swimming and the gym wait until week three to four, and contact sports until week six or later.

Months three to eighteen

Most visible swelling settles within six to eight weeks. The tip keeps refining for twelve to eighteen months, longer with thick skin, so judging the final shape at three months is too early.

Seven to ten days in Istanbul

Packages published by Turkish hospitals and medical travel agencies for septorhinoplasty plan a stay of seven to ten days, and that matches the clinical timeline. The splint visit belongs with the surgeon who placed it.

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The patient room has a companion bed for the hospital night, and the international patients office arranges the hotel for the nights either side and transport between the hotel, the hospital and the airport. From the first message a coordinator stays with you through discharge, and the team works in English, Arabic, French, Russian, Serbian, Romanian and Spanish, with other languages arranged on request, so the consultation that decides the shape happens in your own language, and the same coordinator handles the splint visit, the discharge papers and every question that follows by message once you are home. Say in your first message if you would prefer a female surgeon, and the department will meet the request wherever the rota allows. Halal, vegetarian and diabetic meals come from the hospital kitchen, and a prayer room is on site. Ten days before travel, an invitation letter naming the hospital and the surgeon goes out for the visa application.

What changes the price

Revision changes the quote most.

Compared with a primary operation, a revision takes longer, needs more grafting and frequently needs ear or rib cartilage. Rib harvest adds a second operative field and sometimes a second night, while turbinate reduction, sinus surgery done at the same time or a major tip rebuild each lengthen the time in the operating room and with it the anesthetic. Open and closed approaches differ less in cost than people expect. Age, skin thickness and a history of fracture matter as well, since thick skin calls for more tip grafting and an old fracture may need the bones reset on both sides. Packages for septorhinoplasty in this market include the surgeon and anesthesia fees, the operating room, one hospital night, the splint and dressings, the medication for the first week, the splint removal visit, airport and hospital transfers, an interpreter and a set number of hotel nights, and they leave out flights, travel insurance, extra hotel nights, a CT scan if the surgeon needs one, and any revision later.

When comparing quotes, check whether the figure assumes septal cartilage only or allows for ear or rib, whether turbinate reduction is included if your breathing needs it, and how the hospital handles a revision request in the first year. A meaningful figure comes after a surgeon has seen your photographs and heard what bothers you, and that review costs nothing.

Follow-up, and what to send first

Back home, the follow-up runs on photographs.

Standard views from the front, both sides, the three-quarter angles and from below are sent by WhatsApp at one month, three months, six months and a year, and the surgeon compares them with the photographs taken before surgery. The coordinator stays reachable on the same number for questions in between.

Some signs need a same-day call.

Contact the coordinator for heavy bleeding that does not stop with fifteen minutes of pressure, a fever above 38 degrees, a painful swelling inside the nose, sudden worsening of breathing, or redness spreading across the skin of the nose. A local doctor does the first assessment, and the surgeon speaks to them with the operation note in front of them.

Photos and notes to send

A surgeon can give a useful opinion from a phone camera if the photographs are taken in daylight, without makeup or glasses, with the hair pulled back.

• Front, left side, right side, both three-quarter angles, and a view from below looking up at the nostrils
• A short note on which side is blocked, how long it has been, and which sprays you have tried
• What you would like to change about the shape, in your own words
• Details of any previous nose operation or fracture, and any CT scan of the sinuses you already have

The surgeon replies with whether the combined operation fits, which approach would be used, whether septal cartilage is likely to be enough, and how many days to plan for, at no charge and with no obligation to travel.

Septorhinoplasty FAQ

References

1. van Egmond MMHT, Rovers MM, Hannink G, et al. Septoplasty with or without concurrent turbinate surgery versus non-surgical management for nasal obstruction in adults with a deviated septum: a pragmatic, randomised controlled trial. Lancet. 2019;394(10195):314-321.
2. Halmans Y, Bohringer S, Teunissen EJC, Bommelje CC. Septorhinoplasty and septoplasty: outcomes of a large cohort using autologous versus homologous cartilage, 1999-2019. Aesthetic Plast Surg. 2021;45(2):604-614.
3. Taha HI, Elgendy MS, Ezz MR, et al. Septoplasty versus non-surgical management for deviated nasal septum: a systematic review and meta-analysis of randomized controlled trials. Eur Arch Otorhinolaryngol. 2025;282(2):597-610.
4. Favreau A, Favier V, Carsuzaa F, et al. Olfactory sequelae of nasal surgeries: a systematic review with meta-analysis. J Otolaryngol Head Neck Surg. 2026;55:19160216261416371.
5. Kim DH, Jang DW, Hwang SH. Effects of sphenopalatine ganglion nerve block on bleeding and pain during and after septorhinoplasty: a systemic review and meta-analysis. Aesthetic Plast Surg. 2026;50(3):955-965.
6. Chowdhury R, Al-Musaileem N, Alzayadneh I, et al. Internal nasal dilators after septorhinoplasty: a randomized controlled trial of functional and aesthetic outcomes. Aesthet Surg J. 2026;46(8):875-880.