Repairing septal perforations is a complex issue that will require an in-person consultation with a surgeon who specializes in nasal surgery and rhinoplasty.Repair of a perforation can be done a number of ways, depending on the size, location, and severity of the perforation. They can be repaired directly, by using temporalis muscle fascia, by using Alloderm or a similar product, or by placing a septal button.In addition, you may also have to consider the structural integrity of the bridge of your nose. A septal perforation can weaken the bridge and cause it to "collapse." In these instances, additional surgery to improve the support of your nose may also be needed. Sometimes ear cartilage or rib cartilage is needed to build new structure to your nose.In the end, it is important to find a surgeon who is an expert in nasal surgery and repairs septums often. He/she can provide guidance in the best repair option for you.Best of luck.