Nasal Septal Perforation- surgery success rate with a 5mm hole, due to excessive picking.

Hello, Please see below.Septal perforation repair is one of the most difficult procedures to perform. 
I developed a procedure to repair large septal perforations utilizing a pericranial flap.  The use of this flap can help close larger perforations.  Here are some methods of closure of septal perforation based on size:
-Small (pinpoint)- not advised to fix small perforations, especially asymptomatic perforations that are stable.  These should be observed.  The risk of the procedure of increasing size after repair
-Medium perforations- The use of a variety of techniques can be employed such as sliding flaps (can only repair perforations reliably at 1.5 cm), turbinate flaps (smaller perforations), and endoscopic rotational flaps (less than 1.5 cm) can be utilized.
-Large perforations- The use of pericranial flaps (see above) and free flaps (requires ICU stay) are the only 2 options.  I have had great success utilizing pericranial technique (see video below) to repair septal perforations.

Best, 
Anil Shah MD

You should see a specialist for an examination and full medical assessment to make sure of the cause for your septal perforation.  Sometimes medical treatment with creams and ointments to the septum can help minimise the symptoms you describe.  I understand it is upsetting for you and that  you feel embarrassed - talking it through with a specialist may help you to come to terms with things and feel less so.  If it is 5 mm in size and is due to picking  surgery should be able to close it for you with a high chance of success. 

Thanks for your question regarding the management of a nasal septal perforation. A complete workup and physical examination must be done to assess the location, size, shape, nasal mucosa, sinuses and identification of possible causes for the perforation. If the perforation was caused by trauma (nose picking) and it is of a favorable size and location, septal perforation surgery can successfully be performed via an open approach rhinoplasty with bilateral mucosal nasal tissue advancement flaps and Alloderm interposition. Favorable perforation locations of under 1 cm have a high success rate of closure. Larger perforations, unfavorable locations, infections, prior surgery and other risk factors can also be closed, but at a greater risk for failure to close completely. Certain medical conditions ( i.e Wegener's, Midline granuloma, fungal infection and others ) may preclude you from immediate consideration for surgery. See a specialist who regularly and successfully treats and closes nasal septal perforations and ask for recommendations. Best wishes.