Written by Dr. Litner and Dr. Solieman 01/13/20

If you are reading this page, it is very likely that you have been told that you have a septal perforation. Unfortunately, you may also be discovering that finding a septal perforation repair expert to fix the problem is very difficult. 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 are pleased to treat patients with this condition at PROFILES Beverly Hills, one of the few practices in the country where you can be treated for this complex problem.

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What is a Septal Perforation and How did it Happen?

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 is not simply a one layered hole, as all three layers (the cartilage, as well as the lining on both sides) have been damaged.

How did this happen? The reasons for a perforation vary and can be multifactorial. It is 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 Wegener’s disease, sarcoidosis, tuberculosis, cancer, or syphilis.

We have even seen cases of excessive nose picking causing a septal perforation. The point is, once you have noted potential perforation symptoms, 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 as well as head and neck surgery, we can help you navigate through this process.

What Problems are Caused by a Septal Perforation? 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. 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. In addition, as the perforation becomes larger, you may begin to see signs of nasal collapse.

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

If you are already experiencing some or all of these symptoms, it may not mean the hole is very big. It may just be in a more challenging location. However, this should give you more reason to be evaluated sooner and find a septal perforation repair specialist to help alleviate the symptoms you are experiencing.

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Potential Risks and Temporary Side-Effects Associated with Septal Perforation Repair

Some of the potential risks and temporary side-effects of septal perforation repair surgery include:

  • Bleeding at the incision site or through the nose
  • Nasal discharge
  • Small chance of infection
  • Trouble breathing
  • Pain and discomfort during the recovery
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

What Are Your Options and Why is it so Difficult to Repair the Perforation?

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 simply place a cartilage graft to fill the hole. As stated earlier, it is not simply a one-layered hole; all three layers, the cartilage and the lining on both sides, have been damaged.

Oftentimes, conservative management with the use of nasal irrigation, emollients (nasal moisturizers), and humidification can help alleviate the symptoms of your perforation. When you consult our expert team, depending on the nature of your problem, we can decide what else may be added medically to address your particular issues.

Beyond symptom management, historically, the first line of repair 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
  • The buttons can be dislodged
  • About 10% of patients simply do not 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 are determined or in certain cases, ongoing cocaine use is controlled, as these factors 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 flake and crust. Grafts from inside the mouth have a drying effect because they do not contain the same composition of cells that produce mucus to moisturize your nose. In addition, these grafts have a 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 50% success rate.

Why Choose Drs. Litner and Solieman for Your Septal Perforation Repair in Beverly Hills?

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 PROFILES Beverly Hills invites you to book an appointment so we can make every effort to assist you with this complicated problem.


  • Is septal perforation dangerous?

    There are many factors that can produce a septal perforation. Most of the symptoms associated with this condition can produce severe functional issues and prolonged discomfort, but they are not fatal. Patients that have a perforated septum may experience crusting of the nose, nosebleeds, runny nose, scabbing, nose pains, headaches, and similar symptoms.

  • Can a perforated septum heal on its own?

    In rare cases, the septal perforation can heal on its own. This will depend on the location, size, and extent of the damage itself. The best way to verify that the septal perforation has healed properly is to consult with double board-certified physicians that can help diagnose the issue and provide long-term solutions.

  • What causes septum perforation?

    Septal perforations can be caused by a variety of factors. This includes blunt trauma like accidents or sports injuries, self-inflicted damage due to excessive nose manipulation, or conditions like a nasal hematoma. During your consultation with your physicians of choice, it is important to find the cause and take steps to prevent the re-formation of the perforation after treatment.

  • How common is septal perforation?

    On the whole, septal perforation cases are relatively uncommon as they only occur in less than 1% of the general population. However, at PROFILES, we have earned a reputation as one of the best septal perforation repair specialists teams in Los Angeles. It is common to see patients that have this condition come to Drs. Solieman and Litner to get diagnosed and treated.

  • Can a perforated septum cause headaches?

    Yes, the many symptoms of a perforated septum include headaches, as well as the formation of crusts and an increased chance of sinus infections. While medication may help soothe the discomfort temporarily, the best course of action is to consult with double board-certified surgeons that have a proven track record.


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