Can a Septal Perforation Be Fixed? Does It Need To Be?

Septal perforations can indeed be repaired.  Common symptoms for which people seek repair are crusting, bleeding, whistling, difficulty breathing, and loss of nasal support.   The most common causes of perforations are prior surgery, intranasal drug use, and repeated trauma.  Perforations up to 2.5 cm in diameter can often be fully closed; larger perforations have little chance of complete closure are frequently left alone.

Thanks for the question. Septal perforations (holes in the septum) can absolutely be repaired by ENTs, Facial Plastic Surgeons or Plastic Surgeons. Perforations can occur from nasal trauma, surgery, or exposure of the septum to drugs such as cocaine. This surgery does require specialized training so be sure to consider the surgeon's training and experience carefully before making a decision. 

The bottom line is that a perforation is worth fixing if the patient is experiencing symptoms. The symptoms which can be associated with a septal perforation include difficulty breathing, nasal congestion, persistent crusting, epistaxis (bloody nose), and whistling with breathing. Patients who do not have any of these symptoms may not necessarily need to have the perforations fixed, as long as the perforation is not affecting the structural integrity of the bridge of the nose. 

In general, smaller perforations and perforations closer to the front of the nose are simpler to repair.  Depending on size and location, the perforation can be closed by rotating local flaps in the septum, moving tissue from the turbinates, or bringing in fascia from another location. This temporalis fascia, the thin covering of the temporalis muscle, is harvested by making a tiny incision behind the hairline in the temple.

An exciting new development in septal perforation repair is the use of the PDS plate, approved by the FDA in 2010. This is a very thin (0.15 mm), perforated plate which dissolves slowly over a few months. In my practice, I have successfully repaired many perforations using these plates, covered on each side by septal flaps or temporalis fascia. 

Lastly, surgeons certainly have the right to charge whatever they feel is appropriate for septal perforation repair, or any surgery for that matter, but $50,000 USD does sound exorbitant to me. You shouldn't have to choose between sending your kids to the best colleges and fixing your nose! You may want to consider consulting with other surgeons who also have the specialization and technical skill to perform this delicate operation. 

Best of luck,

Dr. Mehta