Introduction: Septal deviation and inferior turbinate hypertrophy are common causes of nasal airway obstruction (NAO), with septoplasty and inferior turbinate reduction often recommended for symptom relief. Computational fluid dynamics (CFD) has emerged as a powerful tool to simulate changes in nasal anatomy and predict their effects on clinically relevant variables, including mucosal cooling. This study compares the effects of in-vivo and virtual septoplasty with inferior turbinate reduction on nasal airflow dynamics and mucosal cooling using CFD. Methods: Patients with NAO due to septal deviation and inferior turbinate hypertrophy were prospectively recruited at Westmead Hospital, Sydney. High-resolution CT scans were obtained pre- and post-operatively, with segmentation used to create 3D nasal airway computational models. Virtual septoplasty and turbinate reduction were performed on pre-operative models, and CFD simulations were conducted for both virtual and actual post-operative models. Key metrics, including airflow velocity, volume, heat flux, and mucosal and air temperatures, were compared between pre-operative, post-operative, and virtual surgery models. Results: Pre-operative CFD models showed impaired mucosal cooling, turbulent airflow, and increased wall shear stress on the obstructed side. Both in-vivo and virtual post-operative models demonstrated improvements in mucosal cooling, heat flux, and overall nasal airflow. Videos of airflow simulations are provided to visualise these changes. Conclusion: Septal deviation and inferior turbinate hypertrophy disrupt airflow dynamics, leading to reduced mucosal cooling, particularly in the anterior nasal airway. Both in-vivo and virtual surgical interventions improved nasal aerodynamics, including mucosal cooling and heat flux, and reduced airway resistance. Virtual surgery and CFD holds potential for optimising surgical approaches to maximize airflow and post-operative outcomes.