By now there have been several accurate, helpful and well written responses to your question that I agree with....I would add, though that in my practice all functional nasal operations requiring structural grafting are done through an open rhinoplasty approach.....this is the same exposure I utilize for the vast majority of my cosmetic rhinoplasties.....interestingly, the grafting techniques that I use to improve breathing are often the same ones that I use to improve appearance....as such, improvement in the appearance of the nose is often a consequence of functional nasal surgery....in plastic surgery, results that look great usually function well and visa-versa...conversely, poor cosmetic outcomes are usually accompanied by poor function....in the mind of a well trained plastic surgeon, reconstructive and aesthetic goals cannot be separated....while it is not reasonable to perform cosmetic surgery under the guise of reconstructive, I neither believe it to be fraudulent to improve my patients' nasal appearance while fixing these complex breathing problems nor to do it without additional charge...purely cosmetic rhinoplasties, isolated septoplasties and turbinate procedures are a different story

Procedures to correct nasal breathing problems include septoplasty and repair of nasal vestibular stenosis and reduction of the inferior turbinates. These can be billed to insurance. The septoplasty can be performed with an incision inside the nose. The repair of the nasal vestibular stenosis most often requires an incision under the nose and lifting the skin to visualize the nasal dorsum. Turbinate excision is done inside the nose. It takes about 15 minutes. The septoplasty alone takes 30 minutes. The repair of the nasal vestibular stenosis requires harvesting from the septum which is a septoplasty and takes approximately 1 1/2 hours. Again, these can be billed to insurance. If a patient desires simultaneous correction to make the nose look better such as filing down the dorsum or making the tip look smaller this is considered cosmetic surgery and cannot be billed to insurance. In my hands, the cosmetic portion of the procedure is most easily accomplished with an open incision under the nose which allows me to visualize the entire nasal dorsum and the nasal tip for meticulous cartilage grafting and meticulous suturing to refine the nasal dorsum and the nasal tip. My cosmetic rhinoplasties generally take three hours and require septoplasty for cartilage harvesting and grafting. The services must be strictly recorded during surgery and the cosmetic portion paid out-of-pocket by the patient. Otherwise, it would be considered fraud. A good rhinoplasty surgeon will exam the nose with a nasal speculum and brilliant headlight illumination and also use a rigid 0° and 30° endoscope. Nasal endoscopy will determine the angle of the internal nasal valve and determine if you are a candidate for repairing nasal vestibular stenosis and evaluate the full extent of the nasal septum and evaluate the full extent of the inferior turbinates. Remember the surgeon cannot do the cosmetic portion of the procedure and try to get insurance to cover it. Again, this would be considered fraud. Best of luck in your endeavors.

The septum is the bendable cartilage in the middle of the nose. If it is bent or has been broken in the past, it can sometimes lead to obstruction of the air passages. This can be uncomfortable, hinder breathing, and sometimes contribute to sinus infections. For this reason it is often a medically necessary procedure. The procedure is accomplished by making an incision inside the nose.

To fix the outer shape of the nose requires completely separate techniques. It is done often at the same time as septoplasty. Because this procedure focuses on changing the cosmetic appearance of the nose, it is not medically necessary, though it still has the potential for profound positive effects on patient's appearance and well-being. Meeting with a surgeon who performs these procedures regularly is the best bet for learning more about fees, risks, recovery and anticipated outcomes.

In our NY plastic surgery practice, we perform many rhinoplasty and septoplasty surgeries. What each individual patient needs can only be determined in person.

The time to do the procedures, will vary from surgeon to surgeon. Septoplasty generally ranges from 15-30 min. The cosmetic portion may take 30-45 min. An incision across the bottom of the nose or columella is usually not required for a septoplasty, unless the nose is very twisted.

When it comes to insurances, a doctor would be committing fraud if they performed cosmetic portions and billed it to the insurance company.

A septorhinoplasty can require anywhere from 1.5 to 6 hours. Insurance will only cover the septoplasty portion for breathing issues. Shaving down the cartilage and/or lifting the tip a bit can certainly be achieved at the same time as a septoplasty procedure, however, insurance will not cover this. Insurance was generous with coverage in the past; However, they are strict with coverage currently. Rhinoplasty (the cosmetic portions of procedure) can sometimes require hours to achieve perfection. Generally, patients expect perfection on their face. Perfection requires time, and OR time requires anesthesia and operating room personnel. Even if your plastic surgeon performed the cosmetic portion free of charge, your insurance company would not pay for the anesthesia or OR time, which are recorded in your medical record. I hope this helps!

A rhinoplasty will generally involve more work and take longer than a septoplasty however this can be highly variable depending on the nose that you are working with and the goals of the patient. Insurance companies will usually cover surgical fees for a septoplasty because the procedure is usually performed to provide a functional improvement in the airway for the patient. The rhinoplasty takes additional time in the operating room and the surgeon, anesthesiolologist/anesthetist, and the facility need to be paid for that time. Since the rhinoplasty is generally not improving any function for the patient the insurance companies are generally not going to pay for that part of the procedure and so the patient has to pay for that part of the bill.

Not all septoplasties are equal. If a nose is crooked, or the very front of the septum is deviated, it is often more effective to do an "open" approach more like a rhinoplasty with the incision between the nostrils, etc. Anything done to improve breathing or straighten a traumatized nose I consider fair game under insurance. Sometimes this includes filing down a small bump which creates a little room so the nasal bones can be moved back to the midline. Similarly, there are things that can be required to improve breathing that also improve the appearance of the tip. Each case is different and it really comes down to how comfortable the surgeon feels billing insurance for what he or she is doing. Billing insurance for purely cosmetic things is fraud. It is not the surgeon's time that is at issue here, but more so the cost of more anesthesia time and more operating room time. Generally I bill cash for any changes that take more than a couple minutes and which are purely cosmetic.

Review what you need with your surgeon. If you need help with breathing and the fuction of the nose it is an insurance covered procedure. If you want a cosmetic procedure you must pay out of pocket and any other way is fraud. Depending on what you decide on it can take as little as 30 minutes or as long as 3 hours. The incisions can be inside the nose for the septoplasty if that is all you want done. The other answers have been quite thorough.

Septoplasty usually takes 30-60 minutes, rhinoplasty is usually 1-2 hours.

The incisions are different for each of these procedures.

Often a doctor will do rhinoplasty in addition to the septoplasty but because this is an additional procedure there will likely be an additional cost. Often the rhinoplasty is done for cosmetic purposes and this is not eligible for insurance coverage.