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 Perforation Reviews
"I was referred to Dr. Bridges by another plastic surgeon in the Richmond area. He is double board certified as a facial plastic surgeon, and an ENT surgeon. If your problem is in anyway ENT related, avoid a strictly cosmetic facial plastic surgeon or ENT surgeon. Ideally, you want someone double board certified in both areas. I have had 2 prior nose surgeries (ENTs) to try to correct my deviated septum to alleviate breathing problems, allergy symptoms, chronic congestion, sinus pressure, and headaches. During the initial consult, I provided the history of my problem and details of the prior surgeries. I told him, with all that surgeons can do today, a surgeon should be able to FIX MY NOSE!!! I was close to begging him to do so. *sigh* He told me he believed he could improve my condition. I scheduled the surgery for 3 weeks later. I'll admit I was in rough shape after the surgery for about 36 hours due to the anesthesia. (I may have yelped during this time period, though I can't recall. *wink*). I'm writing this review 9 weeks post-surgery. This is the best improvement I've had out of the 3 surgeries. I still have a few months for all the swelling to subside but there is noticeable functional improvement. I'd guesstimate about 60-70%. The good news, Dr. Bridges was able to straighten my septum and somewhat widen a narrow nasal passage; the bad news, my septum doesn't fall down the center of my nose, thereby making one nasal passage twice the size as the other"- B.B. / Yelp / Jun 02, 2013
"Breathing Easier. To Correct Malformation of Cartilage - Midlothian, VA - Dr. Bridges ranks superlative in each of the above categories. I was referred to him by a local ENT doctor in Hampton Roads who said my deviated septum was as bad as he had seen and that it should be attended to by a specialist who had more experience in reconstructive nasal surgery. That was the best advice and referral ever given."- B. / RealSelf / Jul 02, 2012
"Revision Work After Cartledge Collapse After Deviated Septum 10 Yrs Ago - Richmond, VA - I couldn't breathe well at all out of my left side of my nose. I had what was frequent sinus infections, swollen on left side of my face and was with no energy and constant muscle tension and mucus. Miserable. I tried the turbinate revision with a local doctor Dr Lenkowski at Lewis Gale in Roanoke. Maybe slight relief. I was referred to Dr. Park at UVA in Charlottesville who told me "I scared him" he said I had 40% airflow on left and basically there was no guarantee with surgery and so he was not doing it. He said patients he works on are much worse. I clapped my hands together and left 2 mins later after a 5 hour drive total with my children in tow. Don't ever go there..... So, I prayed and thought I know, I know, there is the right doctor who will hear me and I know my body. I know I should be breathing better, this isn't right or normal. If I closed my finger over my right nostril, my good one, and breathe in I about pass out. Light headed and no real airflow. I even tried my husbands sleep Apena machine. Lol. I found a couple doctors that had impressive backgrounds and may could help me. I made 3 appointments. The first doctor was Dr Matthew. From the moment I spoke to Mary his care coordinator I was impressed and felt at ease. She was the only one that took time to hear what was going on with me. She asked me to send pictures too as she realized I lived a long ways away and with the kids was difficult. She called me back one day later after showing Dr Matthew my pictures and said yes he will be able to help you and come on in the next day. I was so thankful. I've never been treated with such care from a doctor. I don't like going to doctors actually and I try and hold out but this was killing me and I was tired of being on antibiotics every month. Dr Bridges said he needed to rebuild me nose like with an internal breathe right strip and used donor cartledge to repair the "tent". He spent 4.5 hours in surgery with me if that tells you anything. That's a long time of care and dedication. Not to mention the hospital he practices out of is like a Hilton/ the friendliest staff and no issues with anthestesia like I had a Lewis Gale for turbinate surgery. I was asleep before I got to OR. Perfect. Yes it was sore after and it's 2 weeks post op and finally I am starting to breathe well from left side. My right side healed much faster but that is because he didn't do as much work on that side. I'll tell you he also did lip filler the day of surgery and that's pros and cons, guess heal the same time but maybe if u want one done at another time u can. Lips are great! He is friendly, kind and compassionate. He is willing to try to make it better and that optimism is what I like! He is the best and I would say if you are having any trouble breathing go to him. Do not chance it with just an ENT who could mess up your nose. Dr Bridges is double board certified in ENT and plastic surgery so he knows structurally how the breathing can be impacted by plastic surgery needs. He will go to bat with you for insurance to cover it. United Health Care tried to get out of paying and Mary and Dr Bridges got it covered."- K. / RealSelf / Oct 18, 2015
"Rhinoplasty and Septoplasty - Midlothian, VA - Dr. Bridges is excellent and talented in what he does! So pleased with the results. Mary who scheduled the appointment as well was so pleasant to work with and my first contact with the office was positive."- C. / RealSelf / Jan 05, 2016
"Although I had suffered from chronic nasal congestion and several back-to back sinus infections, I didn’t realize just how impaired my breathing was until Dr. Bridges corrected several deformities inside my nose, including a deviated septum, enlarged turbinates and a collapsed nasal value. What a joy it is to be able to take big, deep, glorious breaths again! I can now breathe freely and sleep through the night, even in spite of sinus drainage from allergies. And as an added bonus, I also have a heightened sense of taste. I was impressed with the pride that Dr. Bridges takes in his work; his willingness to take the time to explain the anatomy of the nose, what was wrong and how he would fix it; and how genuinely delighted he seemed to be able to make a huge difference in the quality of my life. I have nothing but the highest regard for Dr. Bridges and recommend him without reservation. - North Prince George, VA"- Anonymous / Office Visit / Aug 29, 2013
Open Perforation Surgery
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.
Closed Perforation Surgery
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.
Plan Your Procedure
Septal Perforation Surgery FAQ
Does It Work?
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.
Open or Closed?
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.
Covered by Insurance?
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.
When Can I Exercise?
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.