A septal perforation is a hole in the nasal septum. This causes airflow through the nasal cavity to criss-cross through the hole in the septum causing turbulence, which adds drag to the air as it flows through the nose, causing the sensation of obstruction. Nasal septal perforation repair is ultra specialized, requiring very advanced knowledge of rhinoplasty techniques as well as tissue advancement and grafting.  Placing sutures deep in the nose is extremely delicate and takes supreme concentration and patience. Midlothian, VA facial plastic surgeon Dr. Matthew Bridges M.D. FACS trained with a world-renowned expert in rhinoplasty and septal perforations.  He has extensive experience and a special interest in the repair of septal perforations.

 Septal perforations can be approached via an open rhinoplasty technique, which places a small incision in the skin between the nostrils.  This exposes the nasal cartilages and allows wide access to the septum for repair.  The disadvantage of this approach is the recovery, which can be somewhat longer than the closed approach.  Also, there may be more of a chance of causing external cosmetic changes to the nose due to the more extensive dissection involved.  

Endonasal, or "closed", septal perforation repair involves making incisions only inside the nose.  The term "closed" is a misnomer, since the nose/septum is certainly opened during surgery, but only with internal incisions.   Dr. Bridges does most of his septal perforation repairs using this technique.  There is significantly less external swelling/bruising with this procedure vs the "open" approach.  Also, the risk of unintended cosmetic change is minimized.  Performing closed septal perforation repair is highly technical and requires very advanced surgical skill.  Only surgeons with this skill, such as Dr. Bridges, should even attempt this approach.  

Septal perforation surgery is an outpatient procedure performed under general anesthesia. The approach used during the surgery varies for each patient, depending on the severity of the perforation.  This actual technique used to close the hole is similar in both approaches (closed vs open), however.  The tissue surrounding the perforation is carefully elevated on both sides to separate the flaps and allow the hole to be closed in each flap independently.  This is done with careful suturing inside the nose.  An "interposition" graft of tissue is then placed between the flaps and the flaps are then sewn back together, incorporating the tissue.  Various tissue sources are available for grafting, including tissue from behind the ear, or even from the leg.  Dr. Bridges typically uses acellular dermis, or Alloderm, which is prepared donor tissue that does not require another incision for harvesting.  This tissue works very well.  

After surgery, thin silicone sheets are kept in place on both sides of the septum for 3-4 weeks.  This allows the tissue to completely heal without drying out and is very important in the overall process.  The silicone sheets are typically well tolerated by patients.  With the closed approach, there is usually little to no external swelling or bruising, and external taping/splinting is not necessary.  Overall, the procedure is not particularly painful.  

The success rate of septal perforation surgery depends on the severity of the perforation. About 90 percent of patients who undergo septal perforation surgery (both open and closed techniques) experience a successful procedure with minimal risks and side effects.

The technique used during the procedure depends on the size and severity of the perforation. Most patients with small or medium-sized perforations have closed septal perforation surgery, while patients with larger perforations may reuqire open surgery. During the initial consultation, the surgeon evaluates the perforation to determine which technique would be the most successful.

Some insurance companies may cover the cost of surgery because of its medical effect on patients suffering from a septal perforation. Patients are encouraged to speak with an insurance representative before surgery to find out what will be covered by their insurance policy.

Most patients can return to routine exercise 3-4 weeks after surgery. However, patients should be extremely careful to not hit or injure their nose during exercise.