Some noses which are either twisted, mostly as a result of an accident or patients with difficulty breathing through their nose may need surgery to the septum which is the partition dividing the inside of the nose into two halves if part of the septum is removed it is called an SMR if the septum is moved from one side to the other it is called a septoplasty if surgery to the septum is combined with changing the shape of the nose it is called a septo-rhinoplasty.