At a glance
Functional Endoscopic Sinus Surgery, known as FESS, is a minimally invasive operation that widens the natural openings of the sinuses so they can drain properly and heal.
The sinuses are air-filled spaces inside the skull, behind the cheeks, forehead, and nose. When their drainage channels become blocked, mucus builds up and infections take hold. During FESS, a surgeon passes a thin, lighted tube called an endoscope through the nostril, with no cuts on the face, and uses tiny instruments to remove the tissue or bone causing the blockage. Once the openings are clear, the sinus lining can recover and function normally.
Medical Condition
FESS is recommended when sinus problems do not improve after a full course of medical treatment, usually antibiotics, nasal sprays, or steroid tablets over several weeks.
- Chronic sinusitis (long-term sinus inflammation) that keeps returning despite medication
- Nasal polyps (soft, non-cancerous growths inside the nose or sinuses) that block breathing or drainage
- Recurrent acute sinus infections that happen several times a year
- A deviated nasal septum (a crooked internal wall between the two nostrils) that contributes to sinus blockage
- Fungal sinusitis, where a fungal infection has taken hold inside a sinus cavity
- Mucoceles (mucus cysts that expand and press on surrounding structures)
- Benign tumours or growths within the sinus cavities that need to be removed
- To improve access before treating certain skull-base or eye-socket conditions
FESS is not suitable for everyone. Your ENT specialist will discuss whether another approach is better if any of the following apply.
- Active, uncontrolled bleeding disorders
- Certain medical conditions that make general anaesthesia too risky
- Sinus anatomy that makes endoscopic access very difficult or unsafe
- Malignant (cancerous) tumours that require a different surgical approach or additional treatment first
Risks & Complications
FESS is generally considered a safe operation, but like any surgery it carries recognised risks that a patient should understand beforehand.
- Bleeding from the nasal lining, usually minor and settling on its own, but occasionally needing intervention
- Infection in the sinus or surrounding tissue, treated with antibiotics
- Crusting and dryness inside the nose during healing, causing temporary discomfort
- Scarring or adhesions (bands of scar tissue) that narrow the sinus opening again
- Incomplete removal of diseased tissue, sometimes requiring a second procedure
- Damage to the thin bone separating the sinuses from the eye socket, which can cause bruising around the eye or, rarely, problems with vision
- Injury to the tear duct, leading to watering eyes
- Damage to the skull base, which can cause a leak of cerebrospinal fluid (the clear fluid cushioning the brain). This is uncommon but serious and usually repaired during the same operation
- Rare risk of damage to nearby nerves or, very rarely, the blood vessels around the brain
- General anaesthesia risks such as nausea, sore throat, or, in rare cases, more serious reactions
Preparation & Procedure
Preparation for FESS usually begins one to two weeks before the operation date and involves stopping certain medications, lifestyle adjustments, and pre-operative tests.
Patients are usually asked to stop blood thinners, aspirin, and anti-inflammatory painkillers for about one week before surgery, because these increase the risk of bleeding during the operation. Smoking slows healing and increases infection risk, so most surgical teams ask patients to stop for at least two weeks before and after the procedure. Alcohol is best avoided in the days leading up to surgery.
Because FESS is performed under general anaesthesia (medicine that puts you fully to sleep), you will be asked to fast, meaning no food or drink, for a number of hours beforehand. Your surgical team will give you exact fasting instructions, as these vary by hospital and anaesthetic protocol.
Before the operation, the medical team typically arranges the following tests to confirm you are fit for surgery.
- CT scan (a detailed X-ray of the sinuses) to map the anatomy and guide the surgeon
- Blood tests to check clotting, kidney function, and general health
- An allergy assessment, since uncontrolled allergies can affect outcomes
- An ECG (a heart tracing) and sometimes a chest X-ray for older patients or those with heart or lung conditions
- A nasal endoscopy (a brief in-clinic look inside the nose) to assess the extent of disease
On the day of surgery, the procedure itself usually follows these steps.
- You change into a hospital gown and a nurse checks your vital signs and confirms your identity and consent
- An anaesthetist places a drip in your arm and gives you general anaesthesia so you are completely asleep
- The surgeon inserts a thin endoscope through one or both nostrils, with no external cuts
- Guided by a live video image on a monitor, the surgeon removes obstructing tissue, polyps, or diseased bone using small instruments passed alongside the endoscope
- In some cases, an image-guidance system (similar to a GPS for surgery) is used to navigate near sensitive structures
- The nasal passages may be packed with soft dressings to control bleeding, or a dissolvable material may be placed instead
- You are moved to a recovery room where you wake up under close nursing observation
Aftercare
Most patients go home on the same day or after one night in hospital, but the nose continues to heal for several weeks and the way you care for it during this time strongly affects the final result.
- Nasal rinses with saline (salt water) are usually started within the first day or two and continued for weeks to flush out crusts and keep the passages moist
- Avoid blowing your nose forcefully for at least one to two weeks to protect the healing tissue
- Strenuous exercise, heavy lifting, and bending with your head down are usually restricted for two to four weeks
- Flying should be discussed with your surgeon, as cabin pressure changes can be uncomfortable until healing is underway
- Nasal packing, if placed, is usually removed in clinic within the first day or two after surgery
- Prescribed nasal steroid sprays and sometimes short courses of antibiotics or oral steroids are typically continued at home
- Post-operative clinic visits are scheduled at roughly one week, one month, and three months so the surgeon can clean the healing sinuses and check that the openings remain wide
- Some crusting, mild bleeding, and a stuffed feeling in the nose are expected during the first few weeks and usually settle gradually
- Smoking should remain stopped as it significantly delays healing and increases the chance of the condition returning
- Full recovery, meaning the sinuses functioning as intended, often takes two to three months
Cost & What Determines It
The cost of FESS varies widely depending on where the surgery is performed, the extent of disease, and what is included in the hospital's pricing package.
- Complexity of the case: operating on one pair of sinuses costs less than addressing all four sinus groups, and the presence of polyps or abnormal anatomy adds operative time
- Hospital class and country: a private tertiary hospital in one country may charge several times more than a public or regional private hospital in another
- Whether an image-guidance navigation system is used, as this carries an additional facility fee
- Length of hospital stay: day-case surgery costs less than a one or two night admission
- Anaesthetist fees, which are often billed separately from the surgeon's fee
- Pre-operative tests: CT scan of the sinuses, blood work, and an ECG each add to the total
- Post-operative medications such as nasal steroid sprays, saline rinse kits, and antibiotics
- Follow-up clinic appointments, which may or may not be included in the original quote
Hospital packages typically bundle the surgeon's fee, the operating theatre fee, anaesthesia, nursing care during admission, and basic medications given in hospital. What is often billed separately includes the anaesthetist's personal fee, the pre-operative CT scan, post-discharge medications, and follow-up consultations.
Indonesian patients travelling abroad for FESS generally pay out of pocket, because BPJS Kesehatan does not cover treatment received outside Indonesia, and most Indonesian private insurance policies also exclude overseas medical care. Patients with international private health insurance should verify the exact terms of their policy before booking. Requesting a written cost estimate or a formal quotation from the hospital before travelling is the most reliable way to understand the full expected expense and avoid unexpected bills after the procedure.
Frequently Asked Questions
How long does FESS sinus surgery take?
Most FESS procedures take between one and three hours, depending on how many sinuses need to be opened and whether any polyps are removed at the same time. Your surgeon will give you a clearer estimate once they have reviewed your CT scan, which shows the exact anatomy of your sinuses.
Will I be put to sleep for sinus surgery, and how bad is the pain afterwards?
FESS is almost always done under general anaesthesia, meaning you will be fully asleep and feel nothing during the operation. Afterwards, most people describe the discomfort as pressure or a heavy feeling in the face rather than sharp pain, and doctors usually manage this with standard pain relief medication for the first few days.
How long is the recovery, and when can I go back to work?
Most people feel well enough to return to a desk job within one to two weeks, though this varies depending on how extensive the surgery was. Heavy lifting, strenuous exercise, and blowing the nose hard are typically restricted for at least two to three weeks to allow the sinuses to heal properly, and your doctor will advise when each activity is safe to resume.
How much does FESS sinus surgery cost?
The cost depends on several factors specific to your case, including how many sinuses are treated, whether nasal polyps (small grape-like growths inside the nose) are removed, the length of your hospital stay, and the class of room you choose. Requesting a written estimate from the hospital, based on your CT scan and consultation notes, is the most reliable way to get a figure that reflects your actual treatment plan.
This page is general information, not a substitute for medical advice. Every case is different. Your doctor decides what is right for you.
