Revision Doctor Found Septal Perforation Post Rhino, Is It Ok To Proceed?

I had my initial rhino 2/2010 and am currently in search of a revision due to undesirable/unexpected results. In a recent examination with a new ENT/PS it was brought to my attention that I had a septal perforation. I have noticed some of the symptoms in the past year or so but attributed them to other causes. Is it safe to proceed w cosmetic Sx and leave the perf alone? Shouldn't my initial surgeon told me about the perforation? Will this implicate my aesthetic results?

Doctor Answers 9

A hole in the nose

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The commonest cause of a hole in the septum is surgery. These perforations should be closed if they are causing symptoms. Very small pin holes can cause whistling. Larger holes can cause crusting, bleeding and difficulty breathing. Many holes can be managed without surgery if their edges aren't raw and open. A perforation of the septum is by no means a contraindication for rhinoplasty. In fact it is more commonly a reason to proceed to surgery.

Rhinoplasty Revision in Patient with Septal Perforation.

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You can have a cosmetic revision with a septal perforation as long as the perforation is not large, compromising the support of your nose. Consider repair of the perforation when doing the rest of the revision work because it may get worse in the future.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 43 reviews

Septal Perforation after rhinoplasty

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From your description it sounds like your perforation is small, you do not have many symptoms. If you are considering revision rhinoplasty, without septal perforation repair, you are at risk of the perforation getting bigger, and potentially give you more symptoms.

My priority would be to close the perforation and do the revision at once, if the size of the perforation permits.

Michel Siegel, MD
Houston Facial Plastic Surgeon
4.6 out of 5 stars 113 reviews

A post-op perforation may be OK but dependent on the size of the perforation

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It might be ok to perform another procedure if the perforation is not significant. A small perforation does not have to be repaired. If it is a large perforation, the surgeon may need to get cartilage from other areas such as rib or ear to repair the perforation. It is best to discuss this with your surgeon to see if the perforation needs to be repaired.

Babak Azizzadeh, MD
Beverly Hills Facial Plastic Surgeon
4.1 out of 5 stars 9 reviews

Septal perforation and rhinoplasty revision

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Not all septal perforations need to be treated.  If the perforation is small it can possibly be repaired. if it is large, it  may not and working on the nose in a revision may be affected because of a support issue.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Septal perforation and revision Rhinoplasty

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To answer the question of can a revision Rhinoplasty proceed in the presence of a septal perforation the answer is it depends on the size and location of the perforation.A small perforation may be asymptomatic ( does not cause a problem ) while a large critically placed perforation may preclude surgery. 

Septal perforation repair

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You don't have to have the septal perforation closed during your surgery.

However, if the perforation is small and amenable to closure and you have enough symptoms to warrant it you may want to consider perforation closure. Discuss your options with your surgeon to get a better idea of what would be best for you.

Thomas A. Lamperti, MD
Seattle Facial Plastic Surgeon
4.9 out of 5 stars 22 reviews

Septal perforation.

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If it is small then I would repair it with your revision. Most revisions will require some septal harvest for grafting so it can be incorporated easily. If your revision is going to require significant structural support then it definitely should be repaired if possible.

Michael L. Schwartz, MD
West Palm Beach Facial Plastic Surgeon
4.8 out of 5 stars 12 reviews

Septal Perforation Repair During Revision Rhinoplasty

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Great question... The common symptoms associated with septal perforation include difficulty breathing through the nose, crusting, whistling, runny nose, and nosebleeds. If you are experiencing any of these symptoms, you may be a good candidate to undergo a repair of your perforation. The optimal time to do this is during your revision rhinoplasty, as the approach used in both surgeries is often the same, whether it is endonasal (closed) or open rhinoplasty. Additionally, if cartilage is needed for the revision rhinoplasty, taking this from the septum could possibly enlarge the perforation. Plus, in practical terms, it makes sense to recover from both procedures at the same time. 

Success in septal perforation repair depends on a number of factors, most importantly the size of the perforation and its location. Depending on these factors, the perforation may be repaired by moving flaps of the existing mucosal covering of the septum and/or turbinates or, alternatively, bringing tissue from another location. The tissue most often used is temporalis fascia, the thin covering of the muscle in the temple which bulges when you chew. This tissue is harvested through a small incision behind the hairline in the temple. 

In my practice, I am using an exciting new technology for septal perforation repair, the PDS plate. This 0.15 mm absorbable plate provides structural support to the delicate fascia graft during the healing process. The plate gradually dissolves over a few months, by which time the repair site is generally healed. This technique has enabled the repair of larger perforations and seems to increase the likelihood of successful closure. 

I would advise you to address your concerns in detail with your revision rhinoplasty surgeon prior to making your final decision. In the meantime, using nasal saline spray should help minimize your crusting and nasal congestion. 


Dr. Mehta

Umang Mehta, MD
Bay Area Facial Plastic Surgeon
4.7 out of 5 stars 52 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.