So you’ve had a septoplasty
Fine, I guess I should share some of my story since I share everything else and this would be useful to anyone else needing the same thing. Technically speaking what was done was a combination of surgeries, but I’m going out on a limb and thinking the good ol’ septoplasty is the one most people will be having and so that’s the topic of the day.
IT’S NOT A TUMOR! I just really wanted to say that. But it was, about the size of a golf ball and it was removed roughly two years ago now. The progression was slow, so slow that I didn’t realize I could barely breathe out of my nose until it really became apparent. I still don’t feel comfortable talking about it, but I’m fine now. The experience meant I was able to get my third COVID shot, so I guess it wasn’t all bad (here). And I honestly laugh about it now after the fact, life was rough at that point, my newly purchased home had everything breaking down in it, all the appliances, even the garbage disposal, broke within the span of a few months. But that isn’t the story I’m here to share, the story I’m here to tell is surgical.
It’s official, I did the count and this was surgery number 13 like I thought. This was a revision septoplasty to the first one I had several years ago. Being an idiot I had assumed the VA hospital would tell me everything I needed to know about it, but they didn’t even tell me the proper way to care for myself afterwards, the instructions I got were to elevate, mist my sinuses with a saline solution (to keep them moist), and that changing the gauze under my nose (a little gauze mustache!) 10 to 20 times in the first 24 hours was normal. You’re not supposed to bend over, lift anything more than 15 pounds (7 kg), and no exercise for two weeks. There is much more to the story in terms of healing and care so let’s start with what I’ve had done, what I had done this time, and why some of the information they gave me was shit.
First my original surgery (aside from the excision) was a septoplasty with turbinate reduction. This time it was a septoplasty with a nasal valvuloplasty. So a lot of big words, but let’s take things one a time, then we can get into what to expect and how to take care of yourself.
A septoplasty is a surgery to fix a deviated septum. The septum as far as I can tell has one real purpose and that’s to give your nose shape, it is a wall that divides the left and right side and should run fairly straight down the center of the nose. You can feel it if you touch the middle of the nose (not the bone at the top) or if you were to insert a finger into each nostril, the thing that separates your fingers is the septum. In the days leading up to surgery, I had mine poked at more than a few times. Now maybe your like me and nature came along and screwed you, or maybe it was a traumatic event, you got hit in the nose during baseball practice or something. Whatever the reason if your septum is deviated enough, it can cause a blockage of airflow making it difficult to breathe out of one side (or in my case both sides) of your nose.
The turbinate are bony projections that even after seeing them in an MRI I still can’t wrap my head around the exact shape of them. They are wavy finger like projections covered in tissue and mucus. More often than not if you’re having a septoplasty you’re getting one of these too. The turbinate are there to condition the air as you breathe it in. Its job is to warm and moisten air and trust me when I say you would burn your throat breathing if these weren’t around. I know because I felt like my throat was burning after the surgery for a few months while they “settled down.” The reason this is commonly done with a septoplasty is because the turbinate can swell and grow weird if one side of the nose is chronically overworked (thus blocking both sides!), other causes of swelling/weird growth include allergies, and just bad luck. Oh and if you’ve ever climbed into bed to find your nose completely blocked, you can thank the blood rushing to the turbinate for that one (which is why you will typically find some relief laying on one side or the other and only blocking one side of the nose at a time).
Lastly a nasal valvuloplasty! This was a new one, but part of the complications from the last surgery included needing to rebuild the cartilage for the septum and to reinforce the side walls of the nose. If you were to touch the outside of your nose and breathe in, you may not feel much of a difference. However you may notice that one side (or both sides) collapse in on themselves like a blocked straw when you suck too hard. If you just tried this and found one side collapses significantly, well sorry. Those sidewalls shouldn’t collapse a whole lot, but for whatever reason mine were! So they need to be reinforced. This is probably a common issue and the breathe right nasal strips are literally the non-surgical alternative to fix this problem. Since my septum was not doing so hot, the surgical option was the way to go for me, the nasal strips may be a better option if you don’t feel like wracking up 13 surgeries of your own. To reinforce the walls they normally will take some cartilage from the septum to build a little “tent pole” of support to keep it from collapsing. Since I already had one surgery and the second one already required more cartilage, they took a generous helping from my left ear.
Starting with after the surgery is done, let’s talk recovery!
Day 1 (same day as surgery): So you’ve just had your surgery. Congrats, now you cannot breathe at all and you’re wondering if the doctors are trying to teach you a lesson. Or at least that was the case when I woke up the first time. I fully expected to be able to breathe better only to find that my nose did not work at all. Interestingly this second surgery I woke up able to breathe better and freaked out because I thought the surgery didn’t happen. So 50/50, but if I had to guess based on other stories I read after the first surgery, you will wake up plugged and wonder why you even bothered. For the next week you WILL be mostly/completely plugged. Nothing will change that, you just need to deal with mouth breathing for the next week. I find ice cream, cold water, ice cubes, etc. really help the throat and again you’ll learn intimately the purpose of the turbinate because you feel like you’ve burned your throat especially after waking up from sleep.
If you’re like me and they took a graft from the ear, you probably have some, what I can only describe as foam or fabric of some sort stitched in place to the ear. I thought it was gauze, no this sucker is stitched in. As in not removable. Can you get it wet in the shower? I honestly don’t know because I was never told and I cannot seem to find the answer online. Better safe than sorry, I’m keeping mine dry, but hey if you find the answer feel free to leave a comment! Update: as per my update below, no you shouldn’t get it wet, so I was right to suggest you keep it dry. As always, check with your doctor though, maybe yours can be wet, you won’t know if you don’t ask.
They will probably send you home with a big box of gauze pads, some saline, some tape, some pain medicine, and if you’re lucky better instructions than I got. Some doctors want you to moisten your sinuses with a saline spray 4-6x a day for the next week. This will aid in healing and just keep everything happy inside your nose, which is already very unhappy. My instructions explicitly say that you can expect to change your nose pad (again, think gauze and tape mustache) 10-20 times in the first 24 hours. This is a lie!!!!!!! Or it was for me, I tend to bleed a lot after surgery and I’ve learned to not worry so much about it. If this is your first surgery and you have to change your pad >50 times or more (I went through an entire 200 pack of gauze in the first 8 hours or so) then don’t panic! It will stop… eventually.
Sleep the first night will suck, you’ll still be recovering from the anesthetic, so you’ll fall asleep, wake up, fall asleep, wake up, feel wide awake at some odd hour of the early morning, then pass out a few hours later. All while changing your bandages over and over. You should sleep somewhat upright (to keep the blood from pooling at your head). I opt to sleep on the couch while recovering with a neck pillow and enough pillows around me that I look like I am being eaten alive by them. Hey, it’s comfortable, don’t judge. Now I probably am overkill with it, but I like to remain on the couch until the splints come out, which for me is seven days after surgery. Most of the time this is the case, seven days is the magic number so if surgery is on a Tuesday, splints come out the following Tuesday.
Day 2: You’ll notice a lot of swelling, if you could breathe even a little bit after surgery today you’ll probably find you cannot at all! If you’re a normal person, bleeding will have mostly stopped, but you’ll still have a lot of blood colored discharge from your nose. REMINDER: refrain from blowing your nose. I know you think it will help. You think it would make things all better, it won’t and it could cause more bleeding or more swelling, so just don’t. Trust me on this.
If you’re like me you’ll still be bleeding, just not as bad. I will lay a towel down when I sleep the first few days to make sure I don’t bleed on the couch/bed/pillows/whatever you’re sleeping on, but I think (hope) I’m a special case and most people won’t need that. You may also be on antibiotics. I was prescribed some this surgery, I don’t think I had any last surgery, but it’s been two years so I may have. Take as directed! Mine say to take twice a day, so morning and night. I don’t take any pain medication, ever, for any surgery, so my pain tolerance may be skewed. Today will probably hurt, but I will warn you, it’s not the worst day, so be ready and just try to be comfortable even though there is no comfort to be found.
Sinus rinses (if recommended by your doctor) are a lifesaver for me at this point. It helps (to me) to relieve the pressure a bit and you will feel so much pressure your top teeth will feel like they are hurting and your gums will start to itch. If it’s not recommended, just remember to keep your sinuses moist. It helps. Oh and if you’re like me change your gauze often, it’s a little thing, but it makes me feel less… gross.
Speaking of gross, showering is always welcome! Just keep water away from the nose (don’t let it get inside!) tap water is gross, not gross to drink, but there are things in it that can cause infection in say someone who just had surgery, so no tap water in or around the nose! If you are like me and have a graft taken from the ear, I would recommend keeping it dry. I don’t know if I can get it wet or not, but even if I could I don’t know I would want a big ball of fabric wet blocking my ear like that. I feel like that would be uncomfortable and/or cause an ear infection. Update: After getting my splints removed (and the ear cast thing) I asked specifically about it and was told not to get it wet, so yeah cover before you shower or just wash your hair separately (and carefully). Don’t be like me though, just ask your doctor about aftercare. Specifically, how do I shower/bathe now that I’ve had surgery. Trust me, you’ll thank me later for that tip.
Sleep today will be somewhat easier, but you’ll probably wake up a lot. Ice water, trust me. I have a tall glass of ice when go to bed next to me, when I wake up in the night there’s a good chance it will be completely melted, but it will (hopefully) still be cold or only partly melted if you’re really lucky. Grab a fresh glass if you feel up to it, but we’re entering day three and that’s the bad day.
Day 3: One semi-universal truth I’ve read from other account of surgery is that day three is incredibly painful. I can say for me, both times, day three was the worst. Everything is MAXIMALLY swollen. You can’t breathe, everything hurts, and if you’re like I was this last time you can’t stop your eyes from watering constantly. The good news is after day three things get better, the bad news is you need to make it through day three. Good luck, I wish I had some pearls of wisdom to make this better, but I do not. Ice may help, ice under the eyes (not the nose directly, or at least I wouldn’t recommend it), but other than that you just need to make it through the day. Bleeding at this point should be minimal/none even if you’re like me and a huge bloody bleeder. You’ll probably notice a lot of mucus production from here on out too, just go with it. Embrace the mucus.
Day 4: Things are looking up! If yesterday was hell for you, then I’m sorry, but this day should be a lot better. Both times by day four the bleeding was non-existent and the pain went from incredibly high, to very minimal. It may just be a trick because of how bad day three is, but day four really feels like the promise of what’s to come (splint removal day!). You may be able to breathe out through your nose (or one side). I know the side they do the most work on, in my case anyway, is the side I can’t ever really breathe out of. But on occasion I can breathe at least out through one or both of my nostrils. Small victories. Sleep will still be hard to come by, but you’re probably getting used to mouth breathing at this point, so there’s that at least. Throat will probably suck all the way to the end, but it’s a good excuse to eat ice cream and what not. You may notice you’re coughing up some blood, remember the nose is connected and as gross as it is, it will come out both ends of the sinus, so you may be coughing up stuff for a day or two. I’m so sorry for even mentioning it, I hate it, but it’s something people should be aware of.
Day 5: Much like day four, you’ll find things slowly getting better. If you have any discharge from the nose, it’s probably less bright red and more clear mucus colored (or brown, dark, etc. just not “fresh” blood). Since at this point things are getting better there isn’t as much to write about, but if you’re like me, it’s still exhausting just existing. Plan to chill for the whole week after surgery if possible, but if not, try to take it easy to day three or four at least. At this point you may not even need a tape mustache, or if you do it’s very minimal drainage from the nose. You may start to notice a nasty smell, it will linger a few days, but it does eventually go away.
Day 6: The light at the end of the tunnel (as of this writing today is my day 6). Day 8 is splint removal day and you’ll finally be able to breathe. You will not believe how big those splints are (huge, larger than you would think for a nose) and once they are out you’ll understand why you couldn’t breathe with them in. Both times I could go without the gauze under my nose, but there will be the occasional drips so it may be easier just to leave it. Since you’ve gone almost a full week wearing it, it may not even be that big of a deal at this point. For me I can still only (reliably) breathe out of my nose on one side, sometimes both sides will work. I’m always a little scared to try to breathe in, mostly because of what I’ll smell if I do. You’ll probably still feel exhausted, or at least I know I do.
Day 7: Speaking from the last surgery (since tomorrow is day 7 for me), things will start to settle down a bit more. You may be able to breathe with some difficulty from your nose (in and out for once). You may still have a smell following you around (it’s the inside of your nose you’re smelling, which is nasty from surgery, just don’t think about it too much or don’t breathe through the nose at all and save yourself the horror). Since my gauze today is basically dry (the overnight one) this is where I will probably just carry some tissue around and dab as needed.
Day 8: Splint removal day. You made it! One week post surgery your splints will come out. The doctor will look to see how things are going, possibly suck out any clots that are still hanging out inside the nose, and you’ll finally be able to breathe. I remember the night after the last splint removal was the best sleep of my life. That may be because the week leading up to it was some of the worst sleep, but whatever the reason it was glorious! You will have mucus for a long while after the removal, for me the increased mucus production the first time lasted months! Not a lot, but enough that your nose will feel like it’s constantly running. I’m okay with it though, I can deal with it for the chance to be able to breathe like a normal person again. Best of all, you’re finally clear to blow your nose if you want. You probably will only need to do so a little now, but at least you have the option again!
A nose is an important thing, two surgeries later I still recognize that. If like me you can’t use the damn thing, you may wonder what’s the point? But once it’s working (mostly) correctly, it is a night and day difference. I wish I could say that is the end of the story, but I would be lying if I stopped here. There is one sad, but true, thing I should mention. The next few months your septum will probably try to go back to its old shape. Most doctors over correct to the opposite side to account for this so when it stops trying to correct it ends up straight, but you just never know. You may or may not notice your breathing getting slightly worse a few months after the surgery. Not anywhere close to what it was prior to surgery, but not as great as the first day you had the splints removed either.
If you’re really unlucky (like me) you may find your septum has gone completely crazy and part of it needs replacing. Now I am a special case and have had more than my fair share of bad luck, but just be aware that this could happen to you too. Luckily the second surgery wasn’t nearly as painful as the first, I knew what to expect in terms of recovery, and I managed (mostly) to make sure things go smoothly. I don’t regret either surgery, and I’m particularly hopeful that this is the fix I really want and this will be the closing chapter for my nose.
If that changes or if I think of things to add, I will make another post and try to remember to link it here (no promises). Otherwise, this post is long and detailed enough that I hope it helps take the mystery out of recovery! If you’re found this post because you’re having surgery or just had surgery, well then good luck with recovery and I hope you find relief and a working nose at the end of the journey!
UPDATE! Well, it’s been a journey and while (as of this writing) I’m still a few weeks away from fully healing at least (it can take anywhere from 6-8 weeks to fully heal) my splints are out and I can use my nose again. If you’re interested in hearing about how the splint removal process went this time around you can find that information here.
I probably won’t be writing more about the process unless something comes up, but if you have comments or questions I’m always around to answer/help if I can. Again, good luck to anyone going through this, it can be scary, but from someone who’s done this twice now, it is worth it.