Functional endoscopic sinus surgery (FESS)

What is functional endoscopic sinus surgery (FESS)?

Functional endoscopic sinus surgery (FESS) is keyhole surgery to open up the natural drainage channels of the sinuses, the air spaces around the nose and eyes. Using a thin telescope passed through the nostrils, the surgeon removes diseased tissue, polyps and small amounts of bone to widen the blocked openings. There is no cut on the outside of the face.

It is most often done for chronic rhinosinusitis — long-standing sinus inflammation causing a blocked nose, facial pressure, a reduced sense of smell and a drippy nose — when steroid sprays, saline rinses and other medical treatment have not given enough relief. It can be done with or without nasal polyps.

The key idea is in the name: 'functional' means the aim is to restore the sinuses' normal drainage and let medical treatment work better, not to cure the underlying inflammation. Most people improve, but ongoing sprays and rinses are usually still needed, and a minority need further surgery over the years.

Types & techniques

There isn't one single operation. The right approach depends on you — which is something to discuss with your surgeon.

Options at a glance

These are the main approaches described in this guide. The right option depends on the diagnosis, your goals and what your clinician thinks is safe.

Preparing for your surgery

• See the operating surgeon, who will examine the inside of your nose with a telescope and arrange a CT scan of the sinuses to plan surgery.
• Be ready to discuss whether you have had a proper trial of steroid sprays or drops, saline rinses and any other medical treatment.
• Tell your surgeon about asthma, aspirin sensitivity, allergies and any previous sinus surgery, as these affect the outlook.
• Mention all medicines and supplements, especially blood thinners, which may need managing.
• Stop smoking beforehand if you can, as it worsens inflammation and slows healing.
• Arrange a lift home and someone to stay with you on the first night after a general anaesthetic.
• Plan around one to two weeks off work, and expect a blocked nose at first.

What happens

The operation is usually done asleep under general anaesthetic and takes around one to two hours, depending on how much needs doing. The surgeon passes a telescope through the nostrils and, watching on a screen, removes diseased tissue, polyps and small pieces of bone to widen the blocked sinus openings. There is no cut on the outside of the face.

In some cases a computer navigation system is used to work safely near the eye and the base of the skull. Dissolvable dressings or, less often, packing may be placed inside the nose. Some blood-stained discharge in the first days is normal.

Most people go home the same day. Your nose will feel blocked while it heals, and you will usually be asked to start saline rinses, then later steroid sprays, so the newly opened sinuses can be kept healthy.

Is this operation right for me?

A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.

Before you decide

Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.

Anaesthetic choices

The safest option depends on the operation, your health, the facility and your surgeon/anaesthetist. Ask what is planned and why.

The sinuses sit directly beneath the eye and the base of the brain, so the rare serious risks are to the eye, vision and the thin skull-base bone. These are uncommon in experienced hands, and image guidance can help in complex cases. The everyday reality is that FESS improves drainage but does not cure the underlying inflammation, so ongoing sprays and rinses are still needed. Ask your surgeon about their experience and your personal risks.

Published figures to discuss

Success and complication rates depend on how extensive the disease is, whether polyps are present, and whether it is a first or revision operation. The serious risks relate to the eye and skull base, and are rare in experienced hands. The figures below come from ENT UK patient information and surgical series and should be treated as a cautious guide.

These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.

Recovery — what to expect, and when

Most people are back to normal life within one to two weeks, though the nose stays congested for a while and the lining keeps settling over the following weeks as crusting clears and treatment takes effect.

• A blocked, stuffy nose and mouth-breathing for some weeks
• Blood-stained discharge and crusting inside the nose early on
• A temporary dip in the sense of smell before it improves
• Mild facial pressure or a dull ache around the nose
• A gradual rather than instant improvement in symptoms

Aftercare

• Start saline rinses as advised to clear crusting and keep the sinuses healthy.
• Restart steroid nasal sprays when your surgeon advises to control inflammation.
• Do not blow your nose hard; sneeze with your mouth open in the early days.
• Avoid heavy lifting, straining, swimming and contact sports until cleared.
• Take painkillers as advised and avoid blood-thinning medicines unless told otherwise.
• Attend any clinic cleaning (debridement) and your follow-up appointment.
• Save the clinic's contact number in case of heavy bleeding, eye symptoms, severe headache or fever.

• Lift home and an adult to stay overnight after the anaesthetic
• One to two weeks off work booked
• Saline rinse kit and steroid spray ready at home
• Painkillers collected
• Follow-up and any cleaning appointment noted
• Clinic out-of-hours number saved

Scars and how they heal

There is no cut on the outside of the face, so there is no visible external scar. The surgery is done through the nostrils and any healing happens on the lining inside the nose.

⚠ Get urgent help if…

• Heavy or persistent nosebleed that does not settle
• Swelling, bruising or pain around the eye, or any change or double vision
• A severe headache with neck stiffness or feeling very unwell
• Clear watery fluid dripping steadily from one nostril
• A high temperature, spreading facial redness or worsening facial pain
• Sudden visual disturbance or loss of vision

Who to contact: your surgeon or clinic first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.

General guidance — it doesn't replace the specific advice your surgeon gives you.

Results & realistic expectations

A good result means easier breathing, less facial pressure and a drippy nose, and often an improved sense of smell, with the opened sinuses now letting sprays and rinses work better. ENT UK reports that close to nine out of ten cases are successful for up to five years, with around one in ten people needing another sinus operation within five to ten years.

It does not cure the underlying inflammation, and smell does not always recover. The real measure of success is good long-term control with surgery plus ongoing medical treatment, not a one-off cure. Your surgeon will explain the realistic outlook for your sinuses.

For many people the benefit lasts for years, but chronic rhinosinusitis is a long-term inflammatory condition, so symptoms can return, especially in people with polyps, asthma or aspirin sensitivity. ENT UK reports around one in ten people need a further sinus operation within five to ten years. Continuing sprays and rinses is the main way to keep the sinuses healthy.

Combining with other procedures

FESS is commonly combined with removing nasal polyps and, where a bent septum also blocks the nose, with septoplasty. Balloon widening of some sinus openings may be used alongside tissue removal. Ongoing medical treatment is always part of the plan.

Follow-up & long-term care

You will usually be seen a few weeks after surgery to check healing inside the nose, sometimes with a gentle cleaning of crusts, and to make sure you are back on sprays and rinses. Because the underlying condition is long-term, ongoing review is common, and you should report returning symptoms, eye problems or persistent infection.

• Long-term steroid nasal sprays and saline rinses to keep the sinuses healthy
• Treating asthma and allergy well, as these affect the sinuses
• Attending follow-up and any cleaning appointments after surgery
• Returning promptly if a blocked nose, facial pressure or loss of smell comes back
• Discussing biologic medicines with your specialist if polyps keep returning

Revision and secondary surgery reality

• Around 1 in 10 people need a further sinus operation within five to ten years (ENT UK).
• Recurrence is more likely with nasal polyps, asthma or aspirin sensitivity.
• Good long-term control usually relies on surgery plus ongoing medical treatment.
• Biologic medicines are an option for some people whose polyps keep returning.

Ask your surgeon for their own revision rate, what counts as a revision, and what is included in the written aftercare policy.

What good aftercare looks like

• Clear advice on saline rinses and when to restart steroid sprays.
• A named contact route and warning signs for eye symptoms, severe headache, fluid leak or heavy bleeding.
• Planned follow-up, including cleaning (debridement) of crusts where needed.
• A long-term plan to control inflammation and monitor for recurrence.
• Joined-up care with asthma and allergy treatment where relevant.

What affects the cost

Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:

• The operating surgeon's fee and how extensive the surgery is
• Whether polyp removal or septoplasty is done at the same time
• General anaesthetic and the anaesthetist's fee
• Theatre and facility fees, and any use of image-guidance navigation
• Pre-operative CT scanning of the sinuses
• Follow-up appointments, including any cleaning (debridement)
• Ongoing medical treatment and any further surgery if disease returns

• The surgeon's fee and exactly what operation it covers
• Anaesthetist's fee and the type of anaesthetic
• Theatre and facility charges, including image guidance if used
• Whether pre-operative CT scanning is included
• Number of follow-up and cleaning appointments included
• Cancellation policy
• What happens, and who pays, if disease returns and further surgery is needed

On the NHS? FESS is available on the NHS for chronic rhinosinusitis that has not been controlled by medical treatment; private care is mainly used for faster appointments or choice of surgeon, and medical treatment is available without surgery.

You're entitled to your total cost in writing — including aftercare and any revision — before you decide.

Consent traps and marketing red flags

These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.

Choosing a surgeon safely

• Check your surgeon is on the GMC Specialist Register for this area.
• Make sure they practise at a CQC-registered location, and look for membership of bodies like BAAPS or BAPRAS.
• You're entitled to a two-stage consent process with time to reflect (a cooling-off period). The surgeon who will operate must consent you — not a salesperson.
• Be wary of pressure: time-limited offers, discounts or deposits taken before you've had time to think are red flags, not bargains.
• You're entitled to your total cost in writing — including aftercare and any revision — before you decide.

How Vuemedics verifies every consultant →

Take this to your consultation. A good surgeon will welcome every one of these.

• How extensive does my surgery need to be, and which sinuses are affected?
• What improvement is realistic for my symptoms and my sense of smell?
• What are my personal risks to the eye and skull base, and do you use image guidance?
• What ongoing sprays, rinses or treatment will I need afterwards?
• How likely am I to need further surgery, given my polyps or asthma?
• Would balloon sinuplasty or medical treatment be a reasonable alternative for me?
• Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
• Will you be the surgeon who carries out my operation, and who looks after me afterwards?
• What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
• What does a realistic result look like — and what can this operation not achieve?
• What are my options, including waiting, doing nothing for now, or choosing a different approach?
• Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
• What is the total cost in writing, including any follow-ups, and how much time do I have to decide?

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How we made this page

Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →

Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.

Sources & standards: ENT UK — Functional endoscopic sinus surgery (FESS) ENT UK — Sinus surgery for chronic rhinosinusitis without nasal polyps StatPearls — Sinus endoscopic surgery (NCBI Bookshelf) NICE CKS — Chronic rhinosinusitis Complications of primary and revision FESS — PubMed Nationwide incidence of major complications in endoscopic sinus surgery — PubMed

Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.

Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.