Concierge rhinology · London
Private endoscopic sinus surgery (FESS), by a consultant rhinologist.
A proper FESS by a consultant rhinologist — after twelve weeks of medical therapy, with image guidance where it earns its place, in a day-case theatre, no external scars.
Why patients choose us
- 01
A consultant rhinologist, in theatre
Not a general ENT list and not a training case. A named rhinologist, a proper theatre, image-guided navigation where it earns its place.
- 02
Medical therapy exhausted first
EPOS 2020 says twelve weeks of intranasal steroids and saline rinses come before surgery. We check that box before booking a knife.
- 03
Independent, and free
We are paid by no clinic, so the recommendation is impartial and costs you nothing.
Indicative pricing
What private FESS costs in London.
Indicative ranges across our partner clinics. Send the details and we quote firm figures across two or three options.
In short
A standard FESS in our network: £5,500–£8,500, home the same day.
| Procedure | Indicative range | Typical duration | Recovery |
|---|---|---|---|
| Limited FESS (uncinectomy + maxillary antrostomy) | £4,500–£6,500 | 60 min | Same day |
| Standard FESS (anterior ethmoidectomy + sphenoidotomy) | £5,500–£8,500 | 90 min | Same day |
| Full-house FESS (all four sinuses, bilateral) | £7,500–£12,000 | 2 h | Same day |
| Frontal sinusotomy (Draf II) | £6,500–£9,500 | 90 min | Same day |
| Frontal drill-out (Draf III / modified Lothrop) | £9,000–£14,000 | 2–3 h | Same day / overnight |
| Image-guided navigation surcharge | £600–£1,200 | Included | — |
| Steroid-eluting sinus implant (Propel, per side) | £800–£1,400 | At surgery | — |
| Rhinology consultation only | £250–£450 | 30 min | Same visit |
Prices vary by clinic, by which rhinologist does the case, by extent of disease, and by whether image guidance or a steroid-eluting implant is added. We come back with a firm quote within one working day.
The problem
The right pathway, the right extent, the right long-term plan.
Sinus surgery is done too early on some patients and too late on others. The trick is EPOS 2020 medical therapy first, the right extent second, and lifelong steroid rinses (or biologics) third.
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Not sure it is needed?
Twelve weeks of proper intranasal steroid and saline rinses often is the answer. We check that box before recommending surgery.
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Worried about the extent?
A limited FESS for focal disease, full-house for extensive polyps — decided from CT and endoscopy, not a default template.
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Worried about recurrence?
Long-term steroid rinses are non-negotiable. Biologics and aspirin desensitisation are on the table for severe recurrent disease.
The journey
From enquiry to healed cavity — what happens, in order.
One clinician from first message to review — including the six-to-eight-week healing window.
Phase 1 · Before your procedure
Concierge, off-stage for you
Phase 2 · On the day
A few hours at the clinic
Phase 3 · After
Concierge, back on
- 01
Before
You tell us what is going on
A short, confidential form. Blocked nose, facial pain, lost sense of smell, polyps, how long, what has been tried.
- 02
Before
We come back with a recommendation
Within one working day: whether FESS is the right step, what extent of surgery, and an indicative price. If more medical therapy is worth trying first, we say so.
- 03
Before
CT sinuses and clinic review
A fine-cut CT of the sinuses is arranged if you do not already have one, and the rhinologist reviews it with you before consent.
- 04
On the day
Arrival at the clinic
Arrival, consent and a chat with the rhinologist and anaesthetist. General anaesthetic with topical oxymetazoline to decongest.
- 05
On the day
The procedure itself
One to two hours in a proper theatre. Endoscopes through the nostrils, image-guided navigation for revision or frontal work, no external scars.
- 06
On the day
Home the same day
A short recovery, written aftercare, saline rinses from day one, and home within a few hours. Someone must collect you.
- 07
After
Recovery and review
Crusting for two to three weeks, healing by six to eight. A debridement clinic at two weeks, then long-term intranasal steroid to hold polyps back.
Typical end-to-end: 2–3 weeks from enquiry to procedure. Full cavity healing: 6–8 weeks.
When it helps
When FESS is the right step.
The situations we see most, plus the one red flag that means an emergency rather than an appointment.
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CRSsNP — chronic rhinosinusitis without polyps
Twelve or more weeks of facial pain, blockage, discharge or reduced smell despite three months of intranasal steroids and saline rinses.
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CRSwNP — with nasal polyps
Bilateral polyps confirmed on endoscopy or CT, blocking the nose and dulling smell, not controlled by topical steroids ± a short course of oral prednisolone.
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Allergic fungal rhinosinusitis
Thick eosinophilic mucin with characteristic CT appearance — surgical clearance is central, medical therapy alone rarely holds it.
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Mucocoele or obstructed sinus
A pressure cyst, most often frontal or ethmoid, causing headache, proptosis or bony remodelling on CT — drainage and marsupialisation.
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Recurrent acute sinusitis
Four or more discrete episodes per year with clear intervals — endoscopic surgery to open the drainage pathways.
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Tumour resection or biopsy
Endoscopic access for inverted papilloma, juvenile angiofibroma or sinonasal malignancy, planned jointly with the head-and-neck team.
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CSF leak repair or skull-base access
Endoscopic closure of a spontaneous or post-traumatic CSF leak, or as the corridor to a pituitary or anterior skull-base lesion.
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Red flag: orbital or intracranial spread
A swollen or displaced eye, double vision, severe headache with fever, or altered consciousness with sinusitis is an emergency — A&E, not a clinic booking.
Procedure options
FESS is a family of operations, not one operation.
What each element of endoscopic sinus surgery actually involves — and which fits which pattern of disease.
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Uncinectomy + maxillary antrostomy
The minimum FESS — remove the uncinate process and widen the natural maxillary opening. Enough for many limited disease patterns.
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Anterior + posterior ethmoidectomy
Clearance of the ethmoid air cells, preserving the middle turbinate wherever possible. The core of most polyp surgery.
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Sphenoidotomy
Opens the sphenoid sinus at the back of the nose. Needed for posterior disease and as the route to the pituitary.
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Frontal sinusotomy (Draf I / II)
Opens the frontal recess conservatively. Draf II removes the frontal sinus floor on one side for more reliable drainage.
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Draf III (modified Lothrop)
A single wide common frontal opening across both sides — reserved for revision frontal disease or recalcitrant polyps.
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Full-house FESS
All four sinuses on both sides, typically for extensive CRSwNP or allergic fungal disease.
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Image-guided navigation
Real-time CT tracking of the instrument tip — used for revision surgery, frontal work and any case that approaches the orbit or skull base.
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Steroid-eluting sinus implant
A dissolvable implant (Propel or Sinuva) placed in the ethmoid or frontal recess at the end of surgery to hold the cavity open and drip-feed steroid for around thirty days.
Our vetted London network
A small panel of rhinologists, we picked them.
Consultant rhinologists across central, north, west and south London. Not listed publicly — introductions are made privately, once we understand your case.
Selection criteria
How we choose every rhinologist in our network.
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Consultant rhinologists on the GMC Specialist Register in Otolaryngology
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ENT-UK sub-specialty rhinology fellowship or equivalent
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Image guidance available for revision, frontal and skull-base cases
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Joint working with ophthalmology and neurosurgery for orbital or skull-base disease
Safety and recovery
What to expect afterwards — honestly.
FESS is a common, safe day-case procedure in trained hands. The things worth planning are the medical therapy that comes first, the recovery rinses, and the long-term steroid or biologic plan for polyp disease.
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General anaesthetic, day-case
FESS is done under GA with topical oxymetazoline to decongest. Most patients are home the same day, discharged with saline rinses to start on day one.
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No external scars
Everything is done through the nostrils with rigid endoscopes. No cuts on the face, no packing in the modern setup unless bleeding demands it.
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CSF leak 0.5–1% at the skull base
A small tear in the roof of the ethmoid is the classic complication of ethmoidectomy near the skull base — recognised and repaired at the same sitting when it happens.
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Orbital injury under 0.5%
The eye sits millimetres from the ethmoid. Orbital haematoma is rare but vision-threatening and needs immediate release — the reason experience and navigation matter.
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Epistaxis and adhesions
Some ooze for a few days is normal. Adhesion (scar bands) between the septum and turbinate is the commonest late issue and is broken at the debridement clinic.
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Anosmia risk with olfactory cleft surgery
Bilateral polypectomy that clears the olfactory cleft can permanently affect smell. It is discussed on consent, especially for CRSwNP.
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Polyp recurrence 40–60% at five years
CRSwNP is a lifelong inflammatory disease. Surgery clears the cavity but long-term intranasal steroid rinses are mandatory to hold recurrence back.
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Biologics as an alternative or adjunct
Dupilumab, omalizumab and mepolizumab are NICE-approved for severe CRSwNP — either instead of surgery or afterwards to keep polyps from returning.
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Samter’s triad and aspirin desensitisation
Asthma, nasal polyps and aspirin sensitivity travel together. Aspirin desensitisation after FESS is an option that meaningfully reduces recurrence in this group.
Reading your operation note
Your operation note in four parts. Read the last one first.
Whichever extent of surgery was performed, the note the rhinologist sends you keeps to the same shape.
A quiet reminder
Surgical language is precise and can read coldly — we translate it for you.
If you would like us to talk you through the note before your review, just ask.
- 01 Header
Indication and disease pattern
Why the procedure was done — CRSsNP, CRSwNP, allergic fungal, mucocoele, tumour — and the disease pattern seen on CT.
- 02 Technique
Extent of surgery and adjuncts
Which sinuses were opened, on which side, whether navigation was used, and whether a steroid-eluting implant was placed.
- 03 Findings
Polyps, mucin, anatomy, complications
What was seen at surgery, any histology sent (polyps, mucin, tumour), and any intra-operative issues such as a CSF leak or orbital wall breach.
- 04 Impression
Aftercare, rinses, review, medication
Read this first: saline rinses from day one, when the debridement clinic is, long-term intranasal steroid, and whether biologics or aspirin desensitisation are being considered.
Recognised by major UK insurers
Cover for FESS varies by insurer — usually funded when medically indicated with documented failed medical therapy, sometimes with pre-authorisation for image guidance or steroid-eluting implants. We confirm cover before booking.
Frequently asked
Everything we get asked about FESS.
Quick answers on timing, extent, biologics, recurrence and recovery.
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When is FESS actually needed for chronic sinusitis?
EPOS 2020 recommends surgery only after twelve weeks of maximal medical therapy — intranasal steroid spray, high-volume saline rinses, and for polyps a short course of oral prednisolone — has failed to control symptoms. Surgery is the next step, not the first one.
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What is the difference between limited and full-house FESS?
A limited FESS opens the uncinate and maxillary sinus — enough for focal disease. Full-house FESS clears all four sinuses (maxillary, ethmoid, sphenoid, frontal) on both sides and is what extensive polyp disease usually needs.
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Will the polyps come back after surgery?
For CRSwNP, yes — recurrence is 40–60% at five years. FESS gives you a clear cavity so topical steroid rinses can actually reach the lining, but the underlying inflammation continues. Long-term intranasal steroid is mandatory, and biologics are an option for severe recurrent disease.
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What are biologics and are they on the NHS?
Dupilumab, omalizumab and mepolizumab are monoclonal antibodies targeting the inflammation behind CRSwNP. NICE has approved all three for severe cases — either instead of a second operation or alongside surgery to hold recurrence back. Access on the NHS is via specialist rhinology-immunology clinics.
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How much does private FESS cost in London?
Roughly £4,500–£6,500 for a limited FESS, £5,500–£8,500 for standard, and £7,500–£12,000 for full-house bilateral surgery. Frontal drill-out (Draf III) is £9,000–£14,000. Image guidance and steroid-eluting implants are added when clinically justified.
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How long does recovery take?
Most people are back to office work in a week and full activity by two to three. Crusting inside the nose settles over two to three weeks, and the cavity heals fully over six to eight weeks with daily saline rinses.
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Will I have packing in my nose?
Rarely, in modern FESS. Most cases use no packing at all; some use dissolvable materials or a small steroid-eluting implant. Traditional gauze packing is now reserved for troublesome bleeding.
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Can FESS affect my sense of smell?
Often it improves smell by opening the olfactory cleft. But bilateral polypectomy that strips the olfactory epithelium can permanently reduce smell — an important consent point in CRSwNP surgery.
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When should I go to A&E rather than book a clinic?
A swollen or displaced eye, double vision, severe one-sided headache with fever, or confusion in the setting of sinusitis are red flags for orbital or intracranial spread. Go to A&E the same day.
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