Can you get a revision rhinoplasty done if you have a septal perforation?

Question

Hello, I've gotten rhinoplasty done in the past and I now got a septal perforation. My nose is still crooked and i want my tip to be up more. Can we fix this or is this something we can't? I just don't want to end up with a nose that is collapse and is unrepairable.

Anil R. Shah, MD · Answer

Both procedures can be done safely at the same time.  Specialized expertise is required to do both procedures as most rhinoplasty surgeons do not perform septal perforation repair.

Oakley Smith, MD, FRCSC · Answer

Both rhinoplasty and closing a septal hole can and often are done at the same time. Septal perforations (a hole in the septal wall) often are the result of surgery, so when they are repaired very often revision surgery is also done to the original rhinoplasty. Other times the hole is a complication of just internal work like a Septoplasty and here a patient may or may not combine it with a primary rhinoplasty. If the hole is large, then at times its associated with a depression of the nasal bridge commonly called a "boxer's nose" or " saddle deformity". These damaged noses often also have retraction of the columella. With this problem rhinoplasty is very often required not just for appearance but also for breathing. Generally these noses require rib cartilage harvesting to close off the septal perforation as well as repair the nose.

Adam Hamawy, MD · Answer

Yes, a septal perforation can and should be repaired at the same time you are having a secondary or revision rhinoplasty.  The septum is repaired with some of the tissue lining that is already in the nose and any cartilage that is required for the revision is often taken from the ear.

William Portuese, MD · Answer

Yes, The rhinoplasty procedure can be performed even with a septal perforation that is present. If any cartilage grafting is required for the nasal reconstruction,  then it will have to be harvested from the ear or the rib.

R. Stephen Mulholland, MD (retired) · Answer

Dear  reviewerna,

Thank you for your clinical post.  The primary rhinoplasty procedure resulted in
septal perforation and still some residual crooked nose deformity and bridge
tip insufficiency.  Without a clinical
photograph it is difficult to tell exactly what must be performed, but in
general most experienced rhinoplasty surgeons would attempt to repair both the
septal perforation and enhance your nasal aesthetics with a revision
rhinoplasty at the same time.

As you know from your online research that secondary
rhinoplasty is less predictable usually than primary rhinoplasty and often open
techniques with cartilage grafting may be required.  If the nasal perforation is extensive there
may be compromise of dorsal nasal support and grafting to the nasal dorsum to
maintain bridge projection, as well as tip grafting to enhance tip support is
often required.  It is unlikely that
there will be adequate tissue from your nasal septum and, so, the experienced
rhinoplasty surgeon will need to harvest graft material from your ear cartilage
or from your costral-chondral rib cartilage or even bone grafts.

A thorough consultation with an experienced rhinoplasty
surgeon is essential.  Review of the risk
and benefits in the donor cartilages that are necessary should be discussed and
there is always a risk, which is usually reasonably significant that the nasal
perforation may recur.

I hope this information has been of some assistance and best
of luck.

For more information, please review the link below.

R. Stephen Mulholland, M.D.

Certified Plastic Surgeon

Yorkville, Toronto

Can you get a revision rhinoplasty done if you have a septal perforation?

Answers (5)

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