Perforated Septum and Sunken Nose 20+ Years Post-Rhinoplasty. Causes?

I developed a perforated septum after a severe bacterial sinus infection. After that, my nose sunk in and my face now has a flat effect. I have never done cocaine or any other drugs. I have been on prednisone for many years for rheumatoid arthritis. Are there any other causes for perforation and any causes for my nose to sink in? I'm assuming it's all related to the septorhinoplasty done in 1974 when I was 24 for broken nose and deviated septum. Will send photos if needed.

Doctor Answers 6

Septal perforation and Saddle nose deformity

It sounds like you have a saddle nose deformity. This can result from a septal perforation like you describe. Prior surgery can lead to a septal perforation, but other causes such at autoimmune disease, Wegener's disease, etc. should also be looked into as a possible cause of progressive worsening.

Depending on the perforation size your septum may be able to be repaired. The saddle nose deformity may also be reconstructed as well. Check out my link below to see an example of this.

Seattle Facial Plastic Surgeon
4.9 out of 5 stars 21 reviews

Nasal Collapse Following Septal Perforation

The septum which supports the nose has been weakened by the perforation leading to the nasal collapse. The septum and the other nasal structures can be reconstructed by an experienced surgeon.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 38 reviews

Septal Perforation

A septal perforation can be a very dynamic process. In otherwords, once the perforation exists the future changes in your nose can be slow and ongoing depending on the quality of bloodflow to the septum and the overall stability of the remaining structures. The senario you describe is one we see quite often following injury or unsuccesful surgery. You need to be evaluated by a very experienced Rhinoplasty surgeon who can take care of your problems inside and out.


Richard Galitz, MD, FACS
Miami Facial Plastic Surgeon
4.6 out of 5 stars 11 reviews

Collapsed or saddle nose

It appears that you have a saddle nose deformity - such as illustrated in the link below.  This is the result of loss of cartilage in the septum which can be caused by injury, medications, autoimmune diseases, or infection

Sam Naficy, MD, FACS
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 221 reviews

Septal Perforation


One of the world's experts in repair of septal perforations is located in Houston, TX - Dr. Russell Kridel.  He is a master in treatment of septal perforation and rhinoplasty in general.  You should have him take a look.

Matthew Bridges, MD
Richmond Facial Plastic Surgeon
5.0 out of 5 stars 24 reviews

There could be multiple reasons

Certainly having prior surgery is a probable cause for septal perforation and resulting saddle nose deformity. However other disease conditions should be excluded. Wegener's Granulomatosis is a disease that can cause septal perforation. Sometimes medicated nasal sprays could lead to this although that is very rare. Long term prednisone use may have had some role as well. You also want to have an examination in the nose to rule out any other potential causes.

Samson Lee, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 7 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.