I have a 1.5 cm hole in my septum. It is still possible to have a rhinoplasty done? (Photo)

Question

Hi! I I have hated my nose my whole life. I believe it was broken not too long ago which made everything worse. Upon meeting with a surgeon to discuss a rhinoplasty it's been discovered that I have a 1.5 cm hole in my septum. Is it still possible to have a rhinoplasty done at this point? I worry that since there is not much structure there, it will collapse. Even with a graft. I would really like for a more centered middle line and a narrowed tip. Thank you.

Eric M. Joseph, MD · Answer

If your septal perforation is close to the bottom of your nose, depending on your examination, this may be considered for repair at rhinoplasty surgery. You appear to have thin nasal skin with a wide and bifid tip appearance, and this may be associated with a nasal profile bump. The structure of your nose and the feasibility of rhinoplasty for a smaller and less distracting nasal appearance could be made by a rhinoplasty specialist at a consultation. Hope this helps you. Dr Joseph

Marc Polacco, MD · Answer

Thank you for your question. Before surgery is considered, the first question to ask would be what caused the perforation? There are a variety of things that can lead to a septal perforation, some which would make surgery a bad idea, some not as much. Assuming there isn't a medical reason to contradict surgery, then the rhinoplasty would depend on the surgeon's technique. For example, I've done a rhinoplasty for a patient who had almost no septum, but I was able to reconstruct his nose using rib cartilage. It also depends where the perforation is located on the septum. Long story short, rhinoplasty is likely possible, but it depends on your medical history, as well as nasal anatomic findings which would require an in-person exam.

Oakley Smith, MD, FRCSC · Answer

Thanks for your question. In general it is possible to have a rhinoplasty with a small septal perforation, however it is strongly recommended to discuss options with your rhinoplasty surgeon including repairing the perforation. Having an in person examination will help determine how big the perforation is and how that impacts the surgical plan for you in terms of structure and stability.

Tanveer Janjua, MD · Answer

Yes, both can be done at the same time. The septal perforation does not need to be addressed unless you are having a lot of bleeding or you get a whistling sound when breathing or talking. 
Rhinoplasty will not be effected by the Septal perforation as long as it is done conservatively.
Regards
Dr. J

Ronald J. Edelson, MD · Answer

You can have a rhinoplasty but it depends on where the septal perforation is. You need to have your bridge lowered but you don't want the removed bridge cartilage to break into the septal perforation. As long as that can be accomplished a rhinoplasty can be done.

Stephen Kleid, MBBS, FRACS · Answer

You probably can have a Rhinoplasty, even with a deviated septum.The surgeon will need to assess what caused the perforation (if it was cocaine it is imperative that you never use it again), and ensure that your nasal support and nasal airway will not be compromised by the operation,

Behrad Elmiyeh, MBBS, MRCS, FRCS (ORL HNS) · Answer

Thank you for your questions and for sharing your photographs.
Rhinoplasty can improve your areas of concern. However, Septal perforation complicates your surgery. It is paramount to identify the cause of your Septal perforation first as depending on the cause, healing process maybe adversely effected.
I would suggest that you consult with a nasal surgeon (Rhinologist) with expertise in performing complex rhinoplasty. 
Best wishes,

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