The line between functional and cosmetic nasal surgery is one of the most legally and clinically significant distinctions in ENT practice. Here is what you need to be clear on. What is the core difference in indication? Septoplasty is functional: corrects deviated nasal septum causing nasal obstruction, recurrent sinusitis, or sleep-disordered breathing. Rhinoplasty is cosmetic: changes external nasal shape and appearance. Septorhinoplasty combines both. The indication must be documented precisely because it determines insurance coverage, consent content, and medicolegal protection. Does insurance cover septoplasty in India? Yes, if clearly documented as functional with objective evidence. Required documentation: PTA or acoustic rhinometry showing obstruction, nasal endoscopy report, CT PNS showing deviation, and failure of medical management (nasal decongestants trial documented). CGHS, ECHS, and most private insurers cover it. Pure rhinoplasty for cosmetic reasons is not covered by any insurance in India. When is a combined septorhinoplasty justified functionally? When the external nasal deformity is directly causing or contributing to the functional obstruction. Classic example: post-traumatic saddle nose with septal perforation causing collapse. Or crooked nose where the entire nasal framework is deviated, not just the septum. Document the functional impairment caused by the external component separately from any cosmetic component. What are the most common complications of septoplasty to counsel patients on? Septal perforation (0.5-1.5%), saddle nose deformity if too much cartilage is removed, persistent obstruction (10-15% due to inferior turbinate hypertrophy not addressed), synechiae, and CSF leak (rare, <0.1%). Septal hematoma is an immediate post-op emergency — inspect at 24 hours, drain immediately if found to prevent avascular necrosis. Should you always do inferior turbinate reduction with septoplasty? Yes, in most cases. Inferior turbinate hypertrophy coexists with septal deviation in 70-80% of patients and is the commonest reason for persistent obstruction post-septoplasty. Submucosal diathermy or coblation turbinoplasty is preferred over aggressive turbinectomy to preserve mucosal function and prevent empty nose syndrome. What medicolegal traps should you avoid? Never document a combined surgery as 'only septoplasty' to get insurance approval when rhinoplasty was also done — this is fraud and a Consumer Protection Act liability. Get separate informed consent for functional and cosmetic components. Photograph the nose pre-op from 5 standard angles. Manage patient expectation explicitly in writing: septoplasty does not change the external appearance of the nose.