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Septal Perforation Repair Specialists

A Septal Perforation can disrupt breathing and cause other chronic problems. Our surgeons have been recognized the world over for their expertise in the repair of Septal Perforations.

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A Complex Problem

Written by Dr. Litner and Dr. Solieman

If you’re reading this page it’s very likely you’ve been told that you have a Septal Perforation and, you are unfortunately discovering that finding someone to fix the problem is very difficult. And, to top it off, you may still be confused about what a septal perforation even is, how it got there, and why you may need to get it fixed.

Having trained with the foremost experts in Septal Perforation Repair, Drs. Solieman and Litner at PROFILES are one of the very few sites in the country where you can be treated for this very complex problem.

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What is a Septal Perforation and Why Do You Have One?

You probably already know that your septum is the wall between your nostrils that separates your two nasal passages. This structure is composed of cartilage in the front and thin bone in the back, and it has an overlying layer on both sides made of mucosa (the nasal lining). So, for you to have a septal perforation, it’s not simply a one layered hole; all three layers- the cartilage, and the lining on both sides have been damaged.

How did this happen? The reasons for a perforation vary and can be multifactorial. It’s true that septal perforation can and does occur from snorting cocaine and/or occasionally other drugs, but it can also be a result of previous surgery – like septoplasty or rhinoplasty, trauma to the nose, excessive use of nasal steroids and/or nasal decongestants like Afrin, as well as a host of other medical problems ranging from Wegeners disease, Sarcoidosis, Tuberculosis, Cancer, or Syphilis. We have even seen cases of excessive nose picking causing a septal perforation. The point is, once you are noted to have a perforation, the first thing to do is to get evaluated to determine the cause and the extent of the problem. Because our training is highly specialized in both Facial Plastic Surgery and Head and Neck Surgery, we can help you navigate through this process.

What Problems are Caused by a Septal Perforation and Should you have Surgery to Repair it?

When you have a hole in your septum, the airflow through your nose becomes irregular. As a result, your nose dries out more quickly, causing crusting that obstructs your breathing and that may cause bleeding when the crust falls off. You may also experience recurrent or chronic infections and you may notice a whistling noise as you breathe. If you think about it, you will realize how this process can spiral downwards and exacerbate the situation considerably. The tendency, with the chronic cycle of crusting and bleeding, is for the hole to grow larger and larger over time. And, as the perforation becomes really large, you may begin to see collapse of your nose.

If, you indeed have a Septal Perforation but are not experiencing the problems mentioned above, that’s great news. More likely, the perforation is small and easily repaired. Unfortunately, while not always the case, if you wait, there is the potential for the perforation to expand over time, become symptomatic, and be much harder to fix.

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If you are already experiencing some or all of these problems, it may not mean the hole is very big. It may just be in a more challenging location. But, irrespective, it should give you more reason to be evaluated sooner, if for no other reason than to allow us to help you alleviate the symptoms you are experiencing.

Male face Before Septal Perforation treatment, front viewMale face After Septal Perforation treatment, front viewBeforeAfter
Male face Before Septal Perforation treatment, right side viewMale face After Septal Perforation treatment, right side viewBeforeAfter

*Results May Vary

Male face, Before Septal Perforation treatment, front viewMale face, After Septal Perforation treatment, front view
Male face, Before Septal Perforation treatment, right side viewMale face, After Septal Perforation treatment, right side view

Click here to view more actual patient photos.

*Results May Vary

So What are Your Options and Why is it so Difficult to Repair the Hole?

Start by seeing someone who will determine the cause of the perforation. Once this is done, you can begin to think about your options for repairing it. Unfortunately, very often it is not possible to easily close the hole or to simply place a cartilage graft to fill the hole because, as we stated earlier, it’s not simply a one-layered hole; all three layers—the cartilage, and the lining on both sides—have been damaged.

Oftentimes, conservative management with use of nasal irrigation, emollients (nasal moisturizers) and humidification can help to alleviate the symptoms of your perforation. When you see us, depending on the nature of your problem, we can decide on what else may be added medically to address your particular problems. These medical options address your symptoms but don’t begin to address the cause, the perforation itself.

Beyond symptom management, historically, the first line of management has been the insertion of a septal button. This button is essentially two pieces of silicone plastic that snap together through the hole and thus cover it. The problems with these buttons are:

  • Persistent crusting can occur even after the button is placed in as many as a third of patients.
  • The buttons can be dislodged.
  • About 10% of patients simply don’t tolerate the button for one reason or another.
  • The perforation may continue to enlarge with time.

The final option is to attempt repair and closure of the perforation surgically. Your doctor will not suggest this option until active medical causes or ongoing cocaine use is controlled, as these can significantly harm the chances for success. Traditionally, older methods of septal repair have used various materials such as skin grafts or grafts from inside the mouth to transfer to the nose and recreate your nasal lining. Unfortunately, there are problems with these grafts. Skin, when moved to your nose, still tends to behave like skin everywhere else by flaking and crusting. Grafts from inside the mouth are very drying because they don’t contain the same composition of cells that produce mucus to moisturize your nose. And, to top it off, these grafts have poor blood supply and many of them will not survive, leaving you with the same perforation and nothing gained for your troubles. As a result, these other techniques have only about a fifty percent success rate.

Through many years of experience and training with some of the foremost experts in this field, Los Angeles and Beverly Hills Septal Perforation specialists Drs. Solieman and Litner have adopted modern techniques that promise a significantly greater probability of success. Because of these techniques, our patients have noticed improved airflow and less frequent infections. Drs. Solieman and Litner’s success with this procedure stems from staying up-to-date with the latest advances in septal perforation surgery. So, while the process is laborious and technically difficult, our experienced team at Beverly Hills PROFILES welcomes you to come in so that together, we can make every effort to assist you with this complicated problem.

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