Septoplasty, scared of septum perforation

Dear JasonThe risk of a septal perforation will depend on your anatomy as well as your surgeons skill set. Depending on the location of the spur, there might be a difference in the risk of perforation based on approach. An open book approach during an open rhinoplasty can be advantageous to reduce the risk of perforation in my experience. Look for an experienced and well trained plastic surgeon certified by the American board of plastic surgery or facial plastic surgery, see more than one consult and make a well informed decision.

Septal perforation is a potential complication of septoplasty, but fortunately it is rare in a surgeon well trained in rhinoplasty.  Septoplasty alone can certainly be performed in a closed fashion.  Rhinoplasty can be performed either open or closed depending on the surgeon's experience level with both techniques and the maneuvers required to achieve the desired result.  The open technique offers greater visualization to the surgeon as well as some maneuvers that cannot be performed well with a closed rhinoplasty technique.  I would recommend consulting with a surgeon well versed in rhinoplasty who can thoroughly examine you and provide more specific recommendations to achieve the natural result you desire.  Best of luck.
Ziyad Hammoudeh, MD

So it is dependent on the type of septal deformity but in the hands of an experienced nasal surgeon Septal perforation is an exceedingly rare complication. I would ask your surgeon how many of these he/she performs annually and what their complication rate may be. I typically order a CT of the nose and sinuses before complex septoplasty and perform them all closed, and my personal perforation rate is much less than 1%. Best of luck to you.