What is Functional Endoscopic Sinus Surgery?

Smiling man looking at the camera

What is FESS?

I did my first nasal surgery nearly 30 years ago. I have watched as the treatment of nasal breathing and sinus function has changed and evolved. Functional endoscopic sinus surgery (FESS) has become a widely used surgical technique for the treatment of chronic sinusitis and other sinus disorders. 

Because it has changed so much since my early days learning from some of the greatest sinus surgeons in the world in New York, Seattle, the US Navy and overseas I wanted to devote this blog entirely to FESS. This essay will provide an in-depth exploration of functional endoscopic sinus surgery, including its history, benefits, complications, and pitfalls.

History of Functional Endoscopic Sinus Surgery (FESS)

Functional endoscopic sinus surgery was first introduced in the 1980s as a minimally invasive technique for treating chronic sinusitis. Prior to FESS, traditional sinus surgery involved external incisions and more invasive procedures, often resulting in higher risks of complications and longer recovery times. I remember working with Dr Wymueller at the university of Washington and making external incisions on the forehead to treat frontal sinusitis. 

FESS was pioneered by Professors David Kennedy and Jacques Bercin in the United States and Switzerland, respectively. The development of endoscopes with light sources and cameras allowed surgeons to visualize and access the sinuses through the nasal passages, leading to the development of FESS as a safer and more effective alternative to open sinus surgery.

Benefits of Functional Endoscopic Sinus Surgery

1. Minimally Invasive: FESS is considered to be a minimally invasive procedure that is performed entirely through the nostrils, eliminating the need for external incisions. This results in reduced post-operative pain, faster recovery times, and less scarring compared to traditional open sinus surgery.

2. Improved Visualization: The use of endoscopes provides surgeons with a clear, magnified view of the sinus anatomy, allowing for precise and targeted surgical interventions. This leads to more effective treatment of sinus disease while minimizing damage to surrounding healthy tissue.

3. Preservation of Normal Anatomy: FESS aims to restore normal sinus function by opening blocked or inflamed sinus passages and preserving anatomical structures that contribute to airflow and mucus drainage. This can lead to long-term improvements in symptoms such as nasal congestion, facial pain, and recurrent infections.

4. Customized Treatment: FESS can be tailored to each patient's specific sinus anatomy and disease severity. Surgeons can address individual sinus cavities and structures, ensuring a personalized treatment plan that addresses the underlying causes of sinus disease.

5. High Success Rates: Studies have shown that FESS, when properly performed, is highly effective in relieving symptoms of chronic sinusitis and other sinus disorders. Many of my patients experience significant improvements in symptoms such as nasal congestion, facial pressure, and reduced frequency of sinus infections after undergoing FESS.

Blond woman holding her nose with her head tilted back with sinus troubles

Complications and Pitfalls of Functional Endoscopic Sinus Surgery

While functional endoscopic sinus surgery has many benefits, like any surgical procedure, it is not without risks. Some potential complications and pitfalls associated with FESS include:

1. Bleeding: During surgery, there is a risk of bleeding, which can sometimes be significant and require further interventions to control. Surgeons must carefully manage bleeding to minimize the risk of complications. The risk of bleeding continues well into the post operative period and can occur up to and including 3 weeks post operatively.

2. Infection: There is a risk of developing a post-operative infection, either at the surgical site or within the sinuses themselves. Infections can lead to delayed healing, worsening symptoms, and the need for additional treatment.

3. Scarring and Synechiae Formation: In some cases, scar tissue or adhesions (synechiae) may form within the sinuses following surgery. These can obstruct sinus passages, leading to recurrent symptoms and the need for further procedures to address the scarring. This is minimized with the use of implants that give off steroid for many weeks after the surgery. 

4. Risk of Damage to Surrounding Structures: Due to the intricate anatomy of the sinuses, there is a risk of inadvertently damaging surrounding structures such as the eye, brain, or nerves during surgery. Surgeons must be highly skilled and experienced to minimize these risks.

5. Persistent or Recurrent Symptoms: While FESS is successful in many cases, some patients may experience persistent or recurrent symptoms following surgery. This may require additional treatments or revision surgeries to achieve optimal outcomes.


I started Texas Sinus and Snoring because there is a link between snoring and nasal obstruction. One of the common findings when evaluating the nose for obstruction is some form of chronic sinus inflammation. Although I often alleviate this inflammation with antibiotics or balloon sinuplasty, I am also an expert at functional endoscopic sinus surgery (FESS). 

Functional endoscopic sinus surgery has revolutionized the treatment of chronic sinusitis and other sinus disorders, offering patients a minimally invasive and highly effective surgical option. By restoring normal sinus function and addressing the underlying causes of sinus disease, FESS can significantly improve symptoms and quality of life for many patients.

However, it is essential for patients to be well-informed about the benefits, risks, and potential complications associated with FESS. Surgeons must also approach each case with meticulous care and attention to detail to ensure the best possible outcomes for their patients.

Through ongoing research, technological advancements, and continued refinement of surgical techniques, the field of functional endoscopic sinus surgery continues to evolve, offering hope for improved outcomes and quality of life for patients suffering from chronic sinus disorders.