What Is Septoplasty — and Do I Need One?

Septoplasty is a surgical procedure to straighten the nasal septum — the wall of bone and cartilage dividing your nose into two chambers. When a deviated septum is causing significant nasal obstruction, sinus problems, or sleep disruption that has not responded to conservative management, septoplasty corrects the structural problem directly. At SAWC, it is performed in the office under IV sedation — not in a hospital — with a board-certified anesthesiologist present for every case.

By Franklyn R. Gergits, DO, MBA, FAOCO · Sinus & Allergy Wellness Center of North Scottsdale · Scottsdale, Arizona

If you have been told you have a deviated nasal septum and your doctor has mentioned septoplasty, you probably have questions. What exactly happens during the procedure? How bad is the recovery? And how do you know if you actually need it? Here is the honest clinical picture — the same one I give my patients the day before surgery.

What happens during the procedure?

Before we begin, I pull up your CT scan on the monitor in the procedure room and review it with you. I ask which symptoms bother you most — and the deviation typically mirrors those symptoms. That helps us confirm we are solving the right problem.

Once you are asleep, I place a generous amount of numbing medication on both sides of the septum. I use a lot on purpose — the more local anesthesia in place, the less stimulation the anesthesiologist has to manage, which means you can be kept in a lighter, safer plane of sedation throughout the case.

Once everything is numb, I make a small incision in the front of the septum on the left side. I carefully lift the delicate membranes off the deviated septal bone and cartilage on both sides. Once those membranes are freed up, I remove the abnormally shaped bone and cartilage that is causing the deviation. Then I reposition the membranes back to the midline and assess the result — from front to back, top to bottom. When the septum looks straight, I turn my attention to the inferior turbinates. A septum that was deviated has been pushing those structures out of balance for years. Once the septum is midline, the turbinates need to be balanced to match.

Closure is done with a thin dissolvable suture. Then I place internal splints on both sides of the septum. The splints serve a specific purpose — the memory in the septal lining wants to drift back to the abnormal position it has been in for years. The splints hold the septum in its new midline position for one week, which is long enough for the tissue to set. After that week, the correction is permanent. I also place dissolvable packing adjacent to the inferior turbinates to keep them in the proper position relative to the septum while healing begins.

When you wake up, you may feel that this was not as bad as you expected. That is the numbing medication. It wears off — and that is why I am specific about taking pain medication as written, not waiting until the pain arrives to start.

What is recovery actually like?

The first one to two days are the most uncomfortable. Take the medication as directed — do not wait for the pain to remind you. After day two, most patients are able to transition off hydrocodone and manage with alternating acetaminophen and ibuprofen on a schedule — acetaminophen, then two to three hours later ibuprofen, then back to acetaminophen. As the days pass the frequency naturally drops.

Rest with your head elevated to minimize congestion. Sleep with a humidifier running. If you need to sneeze, sneeze with your mouth open — never through your nose during the first week. No heavy lifting, no bending at the waist. Keep using the saline nasal mist every one to two hours while you are awake — it is not optional, it is part of recovery.

The first week is a rest period. Your body is going through a significant healing process — let it. Listen to what it is telling you. When the splints come out at the one-week mark, that is when patients experience what I call their air high. The difference in airflow is immediately noticeable. For most people that moment is the clearest confirmation that the surgery was the right decision.

What are the real risks?

The honest clinical risks of septoplasty are bleeding, infection, and septal perforation — a small hole that can develop in the septum. In rare cases, a revision procedure may be needed if the septum does not heal in the desired position or if symptoms return. These are the risks I discuss with patients in the exam room. Serious complications are uncommon in experienced hands.

Should septoplasty be combined with other procedures?

That depends entirely on your symptoms, your CT scan findings, and what is driving your nasal airway problem. Septoplasty can be combined in the same session with balloon sinuplasty if chronic sinus disease is present, NEUROMARK® for posterior nasal nerve-mediated drainage and congestion, Eustachian tube dilation if ETD is a contributing factor, and inferior turbinate reduction if turbinate hypertrophy is adding to the obstruction. When procedures are combined, you recover once instead of multiple times — which is a meaningful advantage for the patient.

Who is not a good candidate?

Patients with a pre-existing septal perforation are not candidates — operating on a perforated septum risks enlarging it. A very anterior caudal deviation may require an open rhinoplasty approach that goes beyond what I perform, and those patients are referred to a facial plastics colleague. I do not perform cosmetic nasal surgery — if a patient wants their nose to look different rather than breathe better, I send them to the right specialist. Patients with a perfectly straight septum do not need the procedure regardless of their symptoms — the septum is not the problem. And patients who are poor anesthesia risks are evaluated case by case; their safety takes priority over the procedure.

Why come to SAWC for septoplasty?

Septoplasty at the Sinus & Allergy Wellness Center of North Scottsdale is performed in our office under IV sedation — not in a hospital operating room, not in a surgery center. That means no facility fees, faster scheduling, and a more comfortable, less clinical environment for the patient. A board-certified anesthesiologist is present for every IV sedation case we perform — the same safety standard as a hospital, without the hospital overhead. I have corrected thousands of deviated septums over more than three decades. The experience is not incidental to the outcome — it is the outcome.

Want to Understand More?

This post is part of the Understanding Your Symptoms series on the Airway & Sinus Wellness Review.

→ What Is a Deviated Nasal Septum — and Do I Have One?

→ What Is Balloon Sinuplasty — and Are You a Candidate?

→ What Is NEUROMARK® — and Could It Stop Your Chronic Runny Nose?

→ Can Sinusitis Cause Daily Headaches?

Airway & Sinus Wellness Review — Full Publication

This post is part of the Understanding Your Symptoms series.

About the Author

Dr. Franklyn R. Gergits, DO, MBA, FAOCO is an otolaryngologist and rhinologist with over 30 years of clinical experience treating sinus and nasal airway disease in Scottsdale and the greater Phoenix metropolitan area. He is the founder of the Sinus & Allergy Wellness Center of North Scottsdale and performed the first balloon sinuplasty in Pennsylvania. He holds dual Entellus Centers of Excellence certifications and specializes in office-based nasal and sinus procedures — including septoplasty — performed under local or IV sedation anesthesia without the need for a hospital operating room or surgery center. Dr. Gergits is the originator of the Posterior Sinonasal Syndrome (PSS) hypothesis, a clinical framework identifying pepsin-mediated posterior nasal mucosal injury as an upstream driver of chronic rhinosinusitis. ORCID: 0009-0000-4893-6332.

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This content is for educational purposes only and does not constitute medical advice. Please consult a qualified physician for evaluation and treatment of your specific condition.