Revision rhinoplasty and perforated septum repair - combined surgery?

Question

I had septoplasty for deviated septum in 2000 and tip rhinoplasty in 2012. I currently have a perforated septum and the tip is severely angled making it difficult to breath. I would like both fixed but do not want to do separate surgeries if possible. Is it possible to have a combined revision rhinoplasty and perforated septum repair in the same surgery?

Thomas A. Mustoe, MD, FACS · Answer

Small perforations can be closed without major difficulties, and could conceivably be combined with revision rhinoplasty, but often additional cartilage is needed for the revision and that needs to be thought out and planned.  Larger septal perforations are complex procedures, and in that case the two procedures should not be combined.  Sometimes combining two complex procedures increases the risk of less than optimal outcome.

Bahman Guyuron, MD · Answer

These two procedures can definitely be combined and it is very logical to have one operation to accomplish both goals rather than two. However, it needs to be done by someone who has experience doing this combination to produce a successful outcome.

Matthew Bridges, MD, FACS · Answer

This is definitely possible and would be optimal to do all at once for multiple reasons.  You DEFINITELY need to make SURE you find a surgeon who is a expert in rhinoplasty and especially septal perforation repair.  Septal perforation repair is highly specialized.  You need to find a surgeon whose main focus of their practice is nasal surgery.  I cannot emphasize this enough.  I do septal perforation (and rhinoplasty) closed now, which has multiple advantages.  It is tedious surgery that requires very high concentration with no distractions or time constraints. Most surgeons cannot commit to this level to assure consistent results.  Don't be afraid to travel to find this type of surgeon.  It will be worth it in the long run.

Steven J. Pearlman, MD, FACS · Answer

The open rhinoplasty approach is often used for septal perforation repair, so cosmetic changes can be made at the same time. There are limitations though. For example, Large perforations may not be able to be closed. Large hump removal may not be able to be closed. These are both difficult procedures. You should see a revision rhinoplasty expert for an opinion.

Eric W. Cerrati, MD · Answer

Absolutely, a revision rhinoplasty and septal perforation repair can be performed at the same time.  And, I strongly recommend that plan.  Be sure to see an experienced rhinoplasty surgeon to ensure the highest possible success rate.

William Portuese, MD · Answer

Both procedures can be combined together, but seek out someone who is very experienced. It also depends upon how large the perforation is

Michael J. Yaremchuk, MD (license resigned) · Answer

Hello and thank you for your questions:Without any photographs, it is difficult to evaluate your tip concerns. Given your history of septoplasty and subsequent perforated septum, an in-office consultation with a board-certified Plastic Surgeon with experience in rhinoplasty would be advised, as your case may be challenging and requires a careful and thoughtful approach to achieve an optimal outcome. Best of luck!

Michael Hall, MD · Answer

I am sorry to hear about the septal perforation and difficulty breathing.  Depending on the extent of the reconstruction, it is likely that you can have both procedures performed during the same setting to minimize downtime and recovery.  I would seek a surgeon experienced in both cosmetic rhinoplasty and septal perforation repair.  Make some phone calls to potential surgeons because not all plastic surgeons perform septal perforation repair.  You may need cartilage grafts or a fascia graft depending on the size of the perforation and extent of the revision surgery.  Good luck.

Revision rhinoplasty and perforated septum repair - combined surgery?

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