Rhinoseptoplasty: surgical correction of the nasal septum

To correct a deviated nasal septum and potentially reshape the contours of the nose, it is possible to perform a rhinoseptoplasty: this is the combination of a septoplasty and a rhinoplasty. This comprehensive surgical procedure makes it possible to act on both the appearance of the nose and its breathing function.

What does a rhinoseptoplasty involve?

A rhinoseptoplasty is a surgical procedure to reshape the nose with a dual objective, at once functional and aesthetic. It combines 2 different procedures carried out at the same time, namely:

• a septoplasty aimed at correcting a deviated nasal septum (septal deviation) by reshaping the cartilage and bone of the septum (the wall separating the 2 nasal passages). Its goal is to improve the patient’s breathing and remove obstructions in the airways. A septoplasty may be indicated following, in particular, a trauma (accident, impact) that has caused a fracture of the nasal bones and therefore a deviation of the nasal pyramid. A septal deviation can also be congenital in origin (a structural malformation of the nose);
• a rhinoplasty whose aim is to redefine the proportions of the nose so that its shape or size is more harmonious in relation to the rest of the face. More commonly, patients want to « redo their nose » to make it more attractive.

Where a rhinoplasty corrects the appearance of the nose, a rhinoseptoplasty makes it possible to treat the underlying causes of a nasal obstruction while also redefining its contours. It is therefore the most comprehensive surgical treatment to correct a deviated nose.

Rhinoplasty, septoplasty or rhinoseptoplasty: what’s the difference?

These three nasal procedures are often confused, even though they do not pursue the same goal:

• a septoplasty is a purely functional surgery: it straightens the septum to clear the passage of air, without changing the external appearance of the nose;
• a rhinoplasty is an aesthetic surgery: it reshapes the form of the nose (hump, tip, profile) without necessarily acting on breathing;
• a rhinoseptoplasty brings the two together in a single operation: it corrects the deviated nasal septum while reharmonising the shape of the nose. It is the procedure indicated when breathing difficulty and an aesthetic concern coexist.

When the deformity is mild and no surgery is desired, a non-surgical nose correction with hyaluronic acid (non-surgical rhinoplasty) can sometimes camouflage a small irregularity in the profile — but it never treats a deviation of the septum, which is a matter for surgery alone.

Deviated nasal septum: causes, symptoms and consequences

A deviated nasal septum is very common: the wall that separates the two nostrils is rarely perfectly straight. We speak of a pathology only when this deviation interferes with the passage of air or affects quality of life.

The main causes of a deviated nasal septum are:

• congenital: the septum develops crookedly as the face grows, sometimes from birth;
• traumatic: an impact, a fall or a fracture of the nasal bones (sport, accident) shifts the cartilage or bone of the septum.

When it is marked, a deviated nasal septum can lead to various consequences in everyday life:

• a sensation of a blocked nose, often on one side only;
• snoring and, in some cases, sleep apnoea;
• recurrent sinusitis and nasopharyngitis;
• mouth breathing, fatigue or headaches linked to the poor passage of air;
• sometimes, a visibly deviated or « crooked » nose when the bone is displaced as well.

It is in the presence of these signs, and after confirmation by an ENT examination, that the question of nasal septum surgery arises.

Can a deviated nasal septum be corrected without surgery?

No medical treatment or exercise can permanently straighten a deviated nasal septum without surgery: once deformed, the cartilage and bone do not move back into place on their own, and the septum does not regenerate. Non-surgical solutions are limited to relieving the symptoms without correcting the cause:

• nasal dilators or spreaders and strips, which mechanically widen the nostril during sleep;
• saline rinses and topical corticosteroids, which reduce inflammation and congestion without acting on the septum.

These measures may be enough in the case of a mild and well-tolerated deviation. When the breathing difficulty has set in, only a septoplasty — possibly combined with a rhinoplasty within a rhinoseptoplasty — truly corrects the problem.

Septoplasty and rhinoplasty: which symptoms do they treat?

The procedure to correct the nasal septum often follows a diagnosis made by an ear, nose and throat (ENT) surgeon who identifies the signs of a septal deviation and refers the patient towards this type of surgery. Opting for a rhinoseptoplasty may be motivated in particular by the wish to put an end to the following symptoms:

• from a functional point of view:
  • difficulty breathing;
  • a permanent sensation of a blocked nose;
  • recurrent sinus infections caused by an obstruction of the sinuses;
  • nasopharyngitis (nasal obstructions);
  • snoring (a septoplasty is sometimes described as anti-snoring surgery);
  • sleep apnoea;
• from an aesthetic point of view:
  • a humped nose (an osseo-cartilaginous hump);
  • an asymmetrical nose;
  • a « crooked » nose.

While some people have a nasal deviation with no particular symptom, for others a septoplasty is necessary to put an end to daily discomfort. For still others, on top of the functional discomfort there is also distress at a nose perceived as misshapen. A rhinoseptoplasty is then entirely appropriate to improve airflow inside the nose while restoring self-confidence.

Surgical treatment of a deviated nasal septum

A rhinoseptoplasty is usually performed on an outpatient basis (with discharge from hospital the same evening) under general anaesthesia. It lasts between 1 and 3 hours depending on the complexity of the procedure.

Before the procedure

A rhinoseptoplasty requires at least one preliminary consultation with an ENT surgeon. The surgeon notes the patient’s symptoms (their frequency and intensity), any history relating to the nose (any previous procedures) as well as their expectations.

The surgeon also examines the patient’s nose from every angle, both its external and internal appearance. Various examinations may then be carried out in this context, such as a sinus endoscopy, a facial CT scan or a nasofibroscopy to identify any nasal conditions (polyps, sinusitis, enlargement of the turbinates or of the adenoids, etc.). 3D computer simulations may also be produced from photographs in order to show the patient the potential post-procedure result.

Once the quote has been presented and accepted by the patient, a mandatory consultation with the anaesthetist is scheduled at the latest 48 hours before the procedure.

How a rhinoseptoplasty is carried out in Paris

A rhinoseptoplasty most often takes place through the natural orifices (endonasal incisions), with no surgery on the external surface of the nose unless there is a major nasal deviation. The surgeon begins with the septoplasty and exposes the osseo-cartilaginous structure before straightening the cartilage, or even partially removing it if necessary at the tip of the nose.

The aim of this approach is to straighten the septum in order to create a completely clear airway. When the patient’s nasal configuration is particularly complex, it may in some cases be necessary to remove the cartilage of the septum in order to reshape it outside the nose and then reinsert it (this is known as extracorporeal septoplasty).

As for the more aesthetic side of the procedure (the rhinoplasty), the surgeon can file down the bone responsible for the nasal hump using micro-rasps in order to redraw its contours. Micro-grafts can also help to reshape the bridge of the nose and to correct the tip of the nose and its contour. The tip of the nose can also be refined by correcting the soft tissues. Fine external incisions may then be required.

At the end of the procedure, the surgeon places packing and silicone splints (internal and/or external) inside the nasal passages in order to stabilise the septal correction (endonasal support).

Post-operative recovery

After the septoplasty, the patient may feel difficulty breathing, mainly because of the support packing and the crusts that gradually form, which must then be rinsed regularly with water. Swelling (oedema) that needs to go down after the procedure and bruising around the eyes and nose are also noticeable, but disappear naturally after a few days or even a few weeks. Nosebleeds and watering eyes may also occur. Recovery is, however, generally not very painful, even if painkillers may be prescribed where appropriate.

The nasal packing is usually removed after 24 to 48 hours and the splints are removed about a week after the procedure. The patient may, if necessary, be granted 7 to 14 days off work in the case of a genuine and disabling septal deviation recognised by the medical adviser. Physical activity can be resumed gradually after about 3 weeks.

The results of a rhinoseptoplasty

The functional results of the septoplasty are immediate. The visual results begin to be visible from about ten days, with reshaped contours. The final result generally appears between 3 and 6 months once healing is complete and the swelling has fully disappeared. This result may take longer for the aesthetic rhinoplasty (up to a year). The patient can then breathe normally again (as early as the second month) and can begin to enjoy a new nose shape, potentially more refined and even, which blends in better with the rest of the face.

Nasal septum surgery is one of the most frequently performed ENT procedures. The British NAIROS randomised clinical trial, conducted by the NIHR, confirmed that a septoplasty clearly improves breathing and quality of life in adults troubled by a septal deviation, more so than medical treatment alone. The respiratory benefit obtained is generally lasting once healing is complete.

How much does a rhinoseptoplasty cost in Paris?

The cost of a rhinoseptoplasty procedure in Paris ranges between €3,000 and €8,000. For a septoplasty alone, the price can range between €1,500 and €4,500. The cost of an aesthetic rhinoplasty and its possible insurance coverage ranges between €4,000 and €6,500.

Can a rhinoseptoplasty be reimbursed by the French health insurance system?

A functional rhinoseptoplasty (or septoplasty) may give entitlement to partial or total insurance coverage by the French health insurance system, and possibly by your complementary health insurance. An assessment is then carried out by the medical adviser of the French health insurance system, potentially allowing a positive response to a prior-agreement request made by the surgeon.

The purely aesthetic part of the rhinoplasty, on the other hand, cannot be the subject of any reimbursement and remains entirely the patient’s responsibility.