Septorhinoplasty in London

You may benefit from septorhinoplasty if you experience:

• Nasal obstruction — difficulty breathing through one or both sides of the nose, often worse at night or during exercise
• A deviated septum visible on examination or CT, causing both blockage and external crookedness
• Cosmetic concerns combined with functional problems — for example, a dorsal hump with underlying septal deviation
• Previous unsuccessful septoplasty — where breathing improved but the nose now looks different, or where breathing did not improve because the external framework was not addressed
• Nasal valve collapse — where the sidewall collapses inward during inspiration, often linked to septal or cartilage weakness

Not every patient with a deviated septum needs septorhinoplasty. If your concerns are purely functional with no external deformity, a septoplasty alone may be appropriate. During your consultation, I assess both internal and external anatomy to recommend the right approach.

Key point: Septoplasty alone addresses internal anatomy. If there is any external deformity — crookedness, asymmetry, a hump caused by the deviation — septoplasty will not correct it. Conversely, rhinoplasty that ignores a deviated septum risks creating a beautiful nose that cannot breathe.

My approach to septorhinoplasty draws on dual training in both ENT surgery and facial plastic surgery.

Assessment

• Anterior rhinoscopy and nasal endoscopy to assess the septum, turbinates, and nasal valve
• External examination of skin thickness, tip support, dorsal profile, and symmetry
• Standardised photography from 6 angles
• NOSE scale questionnaire to quantify your breathing obstruction (Stewart et al., 2004)
• Discussion of both functional goals and aesthetic preferences

Surgical technique

• Open approach via a small columellar incision (heals to a near-invisible scar)
• Septoplasty first: repositioning or removing deviated cartilage and bone while preserving an L-strut for structural support
• Spreader grafts where needed to widen the internal nasal valve
• Dorsal modification (reduction or augmentation) as required
• Tip refinement using suture techniques and cartilage grafts from the septum
• Turbinate reduction (radiofrequency or submucosal) if indicated
• All performed under a single general anaesthetic at Weymouth Street Hospital

A meta-analysis of 1,067 patients comparing open and closed rhinoplasty approaches found no significant difference in either functional (NOSE) or aesthetic (ROE) outcome scores, confirming that both techniques are effective when matched to the patient's anatomy (Abi Zeid Daou et al., 2025). I use the open approach for most septorhinoplasty cases because it provides direct visualisation of the septum and structural framework, which is particularly important when addressing both function and form simultaneously.

What I use the septal cartilage for

Cartilage removed during septoplasty is not discarded. It becomes graft material — spreader grafts, tip grafts, or batten grafts — to rebuild and reinforce the nose's structure. A randomised clinical trial demonstrated that septorhinoplasty significantly improved quality of life regardless of whether spreader grafts were placed, though grafts remain important for preventing mid-vault collapse after dorsal reduction (Migliavacca et al., 2025). This recycling of septal cartilage is one reason combining the procedures is more efficient than staging them separately.

The role of turbinate surgery

A prospective cohort study of 99 patients found that combining septoplasty with turbinoplasty produced greater quality-of-life improvement than septoplasty alone, with SNOT-22 scores dropping from an average of 53.6 preoperatively to 8.5 postoperatively (Ríos-Deidán et al., 2025). I assess the turbinates in every patient and include reduction when indicated.

A meta-analysis found that nasal surgery for deviated septum improved pulmonary function, with patients walking an average of 62 metres further in the six-minute walk test after surgery (Baharmand et al., 2023) — evidence that the benefits of correcting nasal obstruction extend beyond the nose itself.

A prospective cohort of 380 rhinoplasty patients reported that self-perceived nasal appearance scores improved from 3.2 to 7.9 out of 10 at six months, with corresponding improvements in quality of life and body image (Luong et al., 2024).

All surgery carries risk. For septorhinoplasty, I discuss the following.

The first comprehensive systematic review of adverse events after rhinoplasty (Sharif-Askary et al., 2020), analysing 36 studies, reported the following incidence ranges:

• Revision surgery — 0 to 10.9% of patients across studies
• Infection — 0 to 4%
• Bleeding — 0 to 4.1%
• Septal perforation — 0 to 2.6%
• Nasal airway obstruction requiring revision — 0 to 3%
• Dehiscence (wound breakdown) — 0 to 5%
• Hypertrophic scarring — 0 to 1.5%

Additional risks I discuss with all patients:

• Asymmetry — minor asymmetries are common in all noses; significant asymmetry may need revision
• Numbness — temporary reduced sensation at the tip, usually resolves within months
• Scarring — the columellar scar from an open approach typically heals to near-invisible

The AAO-HNS clinical practice guideline recommends that surgeons should not routinely place nasal packing at the conclusion of surgery, and perioperative antibiotics should not exceed 24 hours (Ishii et al., 2017). I follow these evidence-based recommendations.

I provide a detailed written consent form covering all risks at your preoperative appointment.