Risk of Perforated Septum After Another Septoplasty?

As a general rule all surgical risks are increased with any revision surgery. A perforated septum is a complication after Septoplasty where the central wall (septum) of the nose develops a hole. The risk is in the 1% range but certainly increases with another Septoplasty. By placing cartilage or leaving cartilage sandwiched between the two linings of the septum, the risk can be reduced. The cartilage will fuse with other cartilage with time and healing.

Septoplasty or rhinoplasty revision has added risks, including perforation of the septum, chronic deformity, scar, and malalignment of the cartilaginous structures of the nose. Discuss the risk of septal perforation with your surgeon. The specific risks depend on the amount of structural support and mucosal lining that is preserved in the nose prior to surgery.

I perform at least 175 Septoplasty surgeries a year. Many of these are revisions. The normal rate of perforation for a primary (1st time) Septoplasty is less than 2%. I believe that number is as high at 5% in revision cases. If you still have obstruction after your 1st procedure you should be assessed by someone who is very experienced and does many revisions. This ensures the best chance of a good outcome with the lowest chance of complications.

Anytime you go back into the nose, you have an increased risk of complications.  Ths soft tissue enveope is usualy thinner, and if you had septal work before, you may not have a lot of septal cartilage to work with.

When patients are considering receiving a revision of their septoplasty a great deal of care must be taken in planning this revision surgery. Patients usually request a revision due to some persistent airway obstruction. Your septum and nasal walls must be closely examined to determine what is the root cause of this persistent obstruction. You may require additional procedures such as surgery addressing the turbinates, or spreader grafts to alleviate a collapse of the internal nasal valves.