Septorhinoplasty in Thailand

Bangkok's large private hospitals have ear, nose and throat departments and plastic surgery departments in the same building, with imaging, operating theatres and a ward on site. That matters more for a septorhinoplasty than for most cosmetic procedures, because the functional part needs an endoscopic look at the airway and often a CT scan of the sinuses before anyone decides what to do. Surgeons at these hospitals commonly trained or completed fellowships abroad, consultations run in English, and international patient desks handle appointments, quotes and paperwork.

For readers in Australia and New Zealand, and for expatriates already living in Thailand, the practical case is simple: a direct flight, a familiar destination and a hospital they can get back to. For readers in Europe and North America the flight is long, and that changes the recovery plan, which the sections below go into.

What to check before you commit:

• Who does the functional part. Ask whether the surgeon does septal and airway work every week or mostly cosmetic reshaping. In Thailand the high-volume cosmetic rhinoplasty is augmentation for Thai and East Asian noses, with implants and tip work; a Western reduction nose with a deviated septum is a different case, so ask to see similar ones.
• Where you will be seen if something goes wrong at home. A hospital in Bangkok cannot see you in Perth or Manchester. Find an ENT surgeon at home before you go and tell them what you are doing.
• What the quote leaves out. Splint removal, a CT scan, the anaesthetist, a night on the ward and a follow-up visit are sometimes separate lines. The cost section below lists what to ask for.
• Time. You need to stay near the hospital until the splints come out and the surgeon has seen you at least once afterwards, and you should not plan a beach holiday around a healing nose. Heat, sun and sea water are not friends of a fresh septorhinoplasty.

A septorhinoplasty is done under general anaesthesia and usually takes a few hours, longer if grafts are needed. The order is generally the septum first, then the outside.

The septum

The surgeon lifts the lining off the septum, removes or repositions the bent pieces of cartilage and bone, and lays the lining back. Enough cartilage is left in place to keep the nose supported. Pieces that were removed are often reused as grafts for the outside of the nose, which is one of the practical reasons to combine the two operations. If the turbinates, the shelves of tissue on the side walls of the nose, are enlarged, they can be reduced in the same session; ask whether that is planned and priced.

The outside

Depending on what you and the surgeon agreed, the hump is lowered, the bones are narrowed and straightened with controlled cuts, the tip cartilages are reshaped and supported with sutures or grafts, and the nostrils may be narrowed. Spreader grafts, thin strips of cartilage placed along the middle of the nose, are common in functional cases because they widen the internal valve that collapses when you breathe in.

Most septorhinoplasties for a deviated nose are done open, because the surgeon needs to see the whole framework to straighten it. Closed is not better or worse, it is a different tool; ask which the surgeon plans for you and why.

Splints, packing and the first night

Thai hospitals commonly place thin silicone splints on each side of the septum and a cast on the bridge. Packing, the gauze that used to be pushed into both nostrils, is used less than it once was, but some surgeons still use it for a day. You usually stay one night on the ward, and you leave with saline rinses, painkillers, an antibiotic if the surgeon prescribes one, and a date for splint removal.

Every clinic on this page quotes on request, so this section explains what the quote is made of rather than putting a number on it that would be wrong for your nose.

How to get a quote you can compare

Ask each hospital for a written quote in Thai baht that lists the surgeon's fee, the anaesthetist, theatre and ward, the pre-operative tests and the post-operative visits, and that says which of those are estimates. Ask what the price would be for a septoplasty alone, so you can see what the cosmetic part adds. Ask whether a revision within the first year is charged, and at what rate. Quotes usually hold for a stated period and are confirmed after the in-person consultation and scan; a deposit is often requested to book theatre time. Most hospitals take international cards, and some add a card surcharge.

The lowest quote

A quote well below the others for the same description deserves a second look at what it leaves out: a clinic without a ward, a general anaesthetic replaced by sedation, no CT scan, no septal work at all. A septorhinoplasty that skips the septum is a rhinoplasty, and you would be flying home with the same blocked nose.

Insurance and rebates

Public schemes and private health funds in Australia, New Zealand, the United Kingdom, Ireland and Canada do not, as a rule, pay for planned surgery abroad, even for the functional part they would have covered at home. Travel insurance excludes elective treatment and its complications. If you hold an international private policy, ask in writing before you book. Expatriates on Thai private insurance or in the Thai social security scheme may find the septoplasty part is claimable when it is medically indicated; the cosmetic part will not be.

Before you fly

Send photographs from the front, both sides and below, and describe the breathing problem: which side, when, and what makes it worse. Many hospitals arrange a video consultation with the surgeon. If you already have a CT scan or an endoscopy report, send it. Stop smoking and vaping well ahead of the date, stop supplements and medicines that thin the blood after checking with your own doctor, and treat any sinus infection first. Book accommodation near the hospital for the whole stay and a return flight that you can move.

Arrival and consultation

Plan to arrive a couple of days before surgery. The surgeon examines the nose inside and out, usually with a small endoscope, and orders a CT scan of the nose and sinuses if you have not had one. Blood tests, and for older patients an ECG and a chest X-ray, are done the same day. This is where the plan and the quote are confirmed, so bring your questions; the list further down this page is a start.

Surgery and the first night

You are admitted in the morning, operated on under general anaesthesia and watched on the ward overnight. Expect a stuffed, aching nose, some blood-stained discharge, bruising under the eyes and a headache. The team shows you how to rinse, how to sleep propped up and what not to do: no blowing the nose, no bending, no lifting.

The first week or so

You rest near the hospital. Swelling and bruising peak in the first days and then start to fade. At a follow-up visit the surgeon removes the septal splints, the cast and any stitches under the nose, and checks the airway. Breathing often feels worse than before at this stage because of internal swelling; that is expected. Once the splints are out and the surgeon is satisfied, you are cleared to travel.

Flying home

Do not book the flight before splint removal. Cabin air is dry and pressure changes make a healing nose feel blocked and can provoke a nosebleed, so: saline spray through the flight, no nose blowing, sneeze with your mouth open, a window seat away from the aisle traffic, and ask the surgeon whether a decongestant spray for the descent is appropriate in your case. Keep the surgeon's written summary and your medication list in your hand luggage, and arrange to see your own ENT surgeon or doctor within the first weeks of getting home.

Septorhinoplasty is a common operation with a well-described set of complications, and a candid surgeon will go through them with you. They include bleeding in the first days or after splint removal, infection, a hole in the septum (a perforation), a persistently blocked nose from swelling, scar tissue or a septum that shifts back, asymmetry or an irregularity you can see or feel, numbness of the tip that usually fades, a change in the sense of smell, and the general risks of a general anaesthetic. A proportion of patients want or need a second, smaller operation to refine the result. Being far from the surgeon does not raise the chance of these problems, but it does make dealing with them harder, which is why the sections on the flight home and on finding an ENT surgeon at home matter.

• How many septorhinoplasties for a deviated nose do you do in a typical month, and can I see cases like mine?
• Are you a plastic surgeon or an ENT surgeon, and who does the septal part?
• Open or closed for my nose, and why?
• Will you need cartilage from my ear or rib, and is that in the quote?
• Will you reduce my turbinates, and is that in the quote?
• Which hospital, and will I stay overnight?
• What does the quote include, and what will be billed separately?
• When will the splints come out, and when can I fly?
• What is your revision policy, and what would a revision cost?
• Who do I contact, and how, if I have a problem after I am home?

Turkey is the destination most of our readers compare Thailand with, and it is where the largest number of clinics on this site operate. The honest answer depends on where you live.

See our page on septorhinoplasty in Turkey for the same questions answered for Istanbul.