Septorhinoplasty: Combining Nose Reshaping with Breathing Improvement

For some patients considering nose surgery, the concerns are both functional and aesthetic. A deviated septum may be interfering with breathing, while at the same time, the external shape of the nose is something the patient would like to address. In these cases, a procedure known as septorhinoplasty may be considered, which combines functional septal surgery with cosmetic reshaping of the nose into a single operation.

This article outlines what a septorhinoplasty involves, who it may suit, how it differs from a standard rhinoplasty, and what the consultation and recovery process generally looks like.

What Is a Septorhinoplasty?

A septorhinoplasty is a combined surgical procedure that addresses both the internal structure and the external appearance of the nose. The procedure is essentially two operations performed together:

• Septoplasty, which corrects the nasal septum (the wall of cartilage and bone dividing the two nostrils) where it is deviated, displaced, or otherwise causing airway obstruction
• Rhinoplasty, which reshapes the external structure of the nose to address aesthetic concerns

By combining the two procedures in a single operation, patients undergo only one period of anaesthesia, one surgical recovery, and one set of associated costs. For patients who have both functional and cosmetic concerns about their nose, this is often a practical approach.

What Is the Difference Between Rhinoplasty, Septoplasty, and Septorhinoplasty?

The three terms are often used interchangeably in everyday conversation, but they refer to distinct procedures.

• Rhinoplasty is purely cosmetic and addresses the external shape of the nose. This may involve adjusting the bridge, refining the tip, reducing or increasing nose size, addressing asymmetry, or modifying the nostrils. A standard rhinoplasty does not involve any work on the nasal septum or the internal airway.
• Septoplasty is purely functional and addresses the internal nasal septum where it is causing airway obstruction. The procedure does not change the external appearance of the nose. Septoplasty is generally performed by ear, nose, and throat (ENT) surgeons or by Specialist Plastic Surgeons with appropriate training, and is often considered medically necessary where the septal deviation is documented as affecting breathing.
• Septorhinoplasty combines both procedures. The internal septum is corrected to address breathing issues, and the external shape of the nose is reshaped at the same time. A single surgical procedure addresses both concerns.

The terminology matters in part because the Medicare and private health insurance treatment of these procedures differs significantly, which is covered further below.

Reasons Patients Consider Septorhinoplasty

There are several reasons a patient may consider a combined septorhinoplasty rather than a standalone rhinoplasty or septoplasty.

1. Both functional and aesthetic concerns: The most common reason is that the patient has both a documented septal deviation affecting breathing and an aesthetic concern about the appearance of the nose. Addressing both in a single operation is generally more efficient than two separate procedures.
2. Previous nasal trauma: A history of nasal trauma, such as a sporting injury or fracture, can result in both a deviated septum and a change in the external shape of the nose. Patients in this situation often consider septorhinoplasty to address both issues at once.
3. Congenital nasal anatomy: Some patients are born with a nasal structure that affects both breathing and appearance. A congenital septal deviation combined with the external nasal shape it produces is a common reason patients consider the combined procedure.
4. Concerns identified during cosmetic rhinoplasty assessment: In some cases, a patient initially seeking cosmetic rhinoplasty is found at consultation to also have a deviated septum that is affecting their breathing. In these circumstances, the surgeon may recommend addressing both at the same time as a septorhinoplasty rather than performing the cosmetic procedure alone.

What Is Involved in a Septorhinoplasty Procedure?

Septorhinoplasty is performed under general anaesthesia in an accredited hospital setting. The duration of the procedure varies depending on the complexity of both the septal and cosmetic components, but it typically takes between two and four hours.

The surgical approach generally involves the following steps:

• Access: The surgeon accesses the internal nasal structure, either through an incision inside the nostrils (closed approach) or via a small additional incision across the columella, the strip of tissue between the nostrils (open approach). The approach used depends on the complexity of the work being undertaken.
• Septoplasty component: The septal cartilage and bone are accessed, and the deviated portions are straightened, repositioned, or trimmed to improve the nasal airway.
• Rhinoplasty component: The external structure of the nose is reshaped according to the surgical plan agreed upon at consultation. This may involve adjusting the nasal bones, refining the cartilage of the tip, and modifying other structural elements.
• Closure: The incisions are closed, and a splint or external dressing is placed to support the nose during the initial healing period.

The specific surgical techniques used vary between patients and depend on the individual anatomy and the goals of the procedure. These are discussed in detail at the consultation.

A Septorhinoplasty Consultation

Before any septorhinoplasty surgery, patients will attend a consultation with a qualified Specialist Plastic Surgeon. The consultation is an opportunity to discuss both the functional and aesthetic concerns the patient is hoping to address, examine the internal and external nasal structure, and determine whether a combined procedure is appropriate.

During the consultation, the surgeon will typically:

• Examine the internal nasal airway and assess the degree of septal deviation
• Assess the external nasal structure, including skin thickness, cartilage strength, and bone structure
• Discuss the patient’s goals for both the breathing and aesthetic outcomes
• Review medical history, including any history of nasal trauma, prior nasal surgery, sinus conditions, or chronic respiratory issues
• Explain the surgical approach, expected recovery, and associated risks

Where significant breathing issues are present, the surgeon may request additional investigations or a referral to an ear, nose, and throat (ENT) specialist before proceeding.

Does Medicare Cover Septorhinoplasty?

The Medicare and private health insurance treatment of septorhinoplasty depends on which components of the procedure are clinically indicated.

The septoplasty component may be eligible for a Medicare rebate where the septal deviation is documented as causing functional breathing issues. Patients who meet the relevant clinical criteria may have applicable Medicare item numbers for this part of the procedure, and private health insurance may contribute to the hospital component of the surgical fee, depending on the level of cover held.

The rhinoplasty component is generally not covered by Medicare when it is performed for cosmetic reasons. Cosmetic rhinoplasty falls outside the criteria for Medicare rebates.

Where a septorhinoplasty is performed, the cost is typically broken down to reflect the medically necessary and cosmetic components separately. The Medicare-eligible portion may attract a rebate, while the cosmetic portion does not. Patients should also note that recent changes to private health insurance rules require that the medical necessity of the septoplasty component be clearly documented in order for coverage to apply.

Eligibility for Medicare and private health rebates is reviewed during the consultation, and patients are encouraged to speak directly with their private health fund to confirm what their specific cover includes.

Recovery After Septorhinoplasty

Recovery after a septorhinoplasty is generally similar to recovery after a standard rhinoplasty, though some patients experience slightly more nasal congestion in the early stages due to the internal septal work.

Recovery generally follows this timeline:

• First week: Rest at home with the head elevated when sleeping. A splint is typically worn on the outside of the nose for the first one to two weeks. Nasal congestion, swelling, and bruising around the eyes are common.
• One to two weeks: The external splint is removed. Most patients are able to return to desk-based work and light activity. Bruising and swelling continue to settle.
• Two to six weeks: Strenuous activity, heavy lifting, and exercise are restricted. Patients are typically advised to avoid blowing the nose or wearing glasses during this period.
• Six weeks to three months: Gradual return to exercise and full activity, as confirmed at follow-up appointments. Most visible swelling resolves during this time.
• Up to twelve months: The nose continues to settle into its final shape as residual swelling fully resolves, particularly around the tip of the nose. The final cosmetic result is generally visible at around the twelve-month mark.

Improvement in breathing is generally noticeable within the first few weeks once the initial post-operative swelling and congestion have settled, though the full functional benefit may not be apparent until the internal healing is complete.

Considering Septorhinoplasty on the Gold Coast

For patients in Queensland considering a septorhinoplasty or rhinoplasty, Dr Terrence Scamp is a qualified Specialist Plastic Surgeon based at 95 Upton Street, Bundall on the Gold Coast, with over 30 years of experience in plastic surgery. The practice sees patients from across South East Queensland, including those travelling from Brisbane, for whom Bundall is approximately one hour south.

To enquire about a consultation, contact the rooms on (07) 5539 1000 or visit the booking information page.

All surgery involves risk. For more information on the risks and complications associated with nose surgery, please visit the surgery risks and complications page. This content is general in nature and does not constitute medical advice. Please consult a qualified medical professional for advice specific to individual circumstances.