Unique perforated septum - is it worth fixing? (photo)

Even small septal perforations can be difficult to repair. If it bothers you it is worth repairing. Just be aware that the surgery may not be successful, but it would leave you no worse off than you are now.

Seek out a Board Certified Facial Plastic Surgeon who regularly performs a huge volume of septorhinoplasty surgery- and you will find your answer. A methodical history followed by a careful nasal exam will quickly reveal  the degree of surgical difficulty, and your selected surgeon can easily describe what his or her game plan may be to achieve your goal. I see a lot of septal perforations, and having a hole in the lowest part (called membranous septum) is rare, but over the last 30 years I have surgically managed four, and because of the relative ease of access-results are very gratifying-100% closure rate.  Find an experienced surgeon in your area who may have the skill and technology to make your dreams come true....

The bottom line is that can be easily corrected especially since it is toward the front part of your septum where there is more available tissue to rotate into the hole and close it. I would recommend seeing a facial plastic or ENT surgeon in your area. Saddling is unlikely to occur with that type of injury although you could develop some tip drooping or ptosis over time.

Such a small membraneous septupm perforation will not cause saddle nose deformity or columellar deformity. You can try fixing it if you have any bothering symptoms. Consult nearby ENT/facial plastic surgeons for this. Thanks.

Dear NewMe__2018,
it is hard to tell for sure without an examination. Based on your photos, it looks like this could be improved with surgery. If you are considering a surgery, I would suggest you to consult a board-certified plastic surgeon. Only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Sure - that one is very anterior (foreward) but should be quite addressable. In many ways it will be easier to repair than ones that are further back.

Nasal septal perforations may arise from trauma, nasal manipulation, cocaine usage, and other conditions that could be more worrisome. If you have a traumatic perforation that is asymptomatic, you should not develop a saddle-nose. If you have excessive whistling, crusting, or dryness, consider consulting with several reputable ENTs or facial plastic surgeons.

Excellent question and understandable worries. Your perforation looks to be in the membranous septum as you described. This is soft tissue and can be sutured closed. We sometimes make a similar incision during rhinoplasty called a full transfixion incision to deproject or set the nose back. Speak to a board certified rhinoplasty surgeon (facial plastic surgeon or plastic surgeon) and they should be able to help you correct that. There is no need to worry about a saddle nose developing as this is not in the cartilage that supports your nasal bridge. Your columella may become lifted or tucked up in the process of closing this but it will not deteriorate. A small graft using cartilage could address the lifted or tucked in appearance of the columella if it were to develop or be obvious during the closure. 
All the best,
Dr. Brace

Dear NewMe, This should be quite easy to fix in the hands of an expert surgeon. Best regards, Michael V. Elam, M.D.