Should I get my septum perforation fixed?

Not all septal perforations need fixing. In fact the majority are asymptomatic and they certainly don't need surgery. Then there's a significant number of perforations which can be managed medically. This requires perseverance and time but often results in such a reduced symptom load that surgery is no longer required. Finally the remaining symptomatic perforations are possible surgical candidates. However the larger the perforation, the less likely surgical success. So when all septal perforations are grouped together, only a small number need surgical fixing. 

This is complex surgery but can be very successful.  The surgeon must be prepared to stabilize the remaining septum to prevent future collapse.  This will frequently require cartilage grafts, either from the ear or rib.  Make sure you seek out an expert in this type of surgery.  It is beyond the scope of most rhinoplasty surgeons. 

Large septal perforation repairs are very difficult both technically and to achieve complete closure. The safest and most expedient fix is a septal button. Reconstruction will likely require cartilage grafts and septal flaps with allogeneic dermis. Rhinoplasty can be performed 'over' a septal perforation with emphasis on structural support/maintenance.

Septal perforation can cause crusting and nasal bleeding, loss of smell, and whistling and even collapse of the bridge,  which make them quite challenging.The repair is not a simple matter and a silicone button is the expedient "fix".Permanent repairs are possible with septal flaps, and attention to support of the nose, however are difficult for some so choose a surgeon interested is these problems.

If you are having significant problems you can either surgically repair the perforation or use a septal button to block the opening.  The button does not have a risk of collapse but does not permanently repair the opening.  Good luck.  Donald R Nunn MD  Atlanta Plastic Surgeon