What is a Septal Perforation

Septal perforation repair surgery is usually an outpatient procedure. The length of the surgery depends on the size and location of the perforation. On average, septal perforation repair surgery can take from 4-6 hours in the operating room.

Recovery time from septal perforation repair surgery is similar to revision rhinoplasty surgery. The recovery period is about 10 to 14 days. However, most patients are up and about within several days. Although great care must be taken not to re-injure the nose and to closely follow the post-operative care instructions provided by Dr. Kridel and our clinical staff. There will be some swelling and some bruising, which varies by patient. Dr. Kridel asks out of town patients to stay for 10-14 days to provide post-operative care and monitor closure and healing of the septal perforation repair.

At Facial Plastic Surgery Associates we take great pride in the level of patient care we provide our patients every step of the way, from consultation to your final post-operative visit. We believe you will not find a more caring, compassionate, and thorough level of care. The surgery will likely take place in a nearby outpatient surgical facility. Patients will need to have someone drive them home after released from recovery. The very next day, Dr. Kridel will remove the dressings. Patients may be instructed to use saline nose drops 3 to 4 times per day to keep the inside of the nose moist, which also allows easier suctioning over the next 7 to 10 days. Using cotton-tip applicators, patients are encouraged to carefully place antibacterial ointment on any incisions and with the nose to prevent post-operative crusting. The external nasal splint is usually removed at about 5 to 7 days, and then the nose is usually taped for another 5 days.

Septal perforation repair surgery costs are approximately $25,000-$30,000 with operating room and anesthesia fees. The OR and anesthesia fees are paid directly to the facility.

For the vast majority of patients, septal perforation repair surgery is considered medically necessary and could be covered by varying degrees by your health insurance. Dr. Kridel is an out-of-network provider, so payment will be required in advance of the surgery. However, our office can help you determine your eligibility in advance and provide you with the appropriate paperwork you need to file with your provider directly after the surgery is performed.

Treatment options vary according to the severity of symptoms. On one end of the spectrum, asymptomatic (without symptoms) patients with small perforations may not require any treatment. Such patients should be advised to keep the nose moist when in dry climates with the use of petrolatum-based ointments. Small perforations may also respond to occasional use of nasal saline sprays or saline gel to maintain adequate moisture inside the nose. However, it is imperative that patients with small perforations monitor their condition to make sure the hole does not expand in size.

For those patients with mild symptoms, such as crusting, frequent therapy with nasal irrigations and ointments/emollients is suggested. One recommendation is an antiseptic wash of one teaspoon of table salt dissolved in a quart of warm water as a nasal irrigant delivered via a Water Pik™ device with a nasal adapter. Corn syrup or glycerin can be added to the saline mixture as a moisturizing and coating substance, which further reduces nasal crusting. A teaspoon of vinegar or 1 to 3 tablespoons of boric acid powder can help decrease bacteria growth. If there is a chronic infection, antibacterial ointments, such as Bacitracin or Bactroban, may be initiated. A cool mist vaporizer by the bedside might also be helpful.

Many patients are bothered by such laborious and time-consuming regimens and may prefer other solutions. A silicone grommet prosthesis does not fix the perforation but may help restore better nasal airflow. The commercially available buttons are not always of proper size to fit larger perforations, in which case a custom silicone button can be fabricated by the local prosthetist once given the proper dimensions by the physician. The standard or the custom made septal buttons usually can be inserted in the office under local and/or topical anesthesia. When these buttons are in place, occasional nasal irritations still may be necessary to keep it clean. It may also need to be removed for more adequate cleaning and for an integrity check every year. Such buttons are for patients who are not good surgical candidates for medical reasons and should also be considered for those patients with a chronic or recurrent disease process. Because there is volume to these grommets, some patients feel they obstruct their nasal airway. While some patients tolerate the buttons for many years, many patients do not. Careful observation and care needs to be taken with this approach as it can also make a hole larger.

Dr. Kridel specializes in permanent surgical solutions to repair septal perforations and does not perform procedures for placement of septal buttons.

Repairing a perforation is complex enough without adding further procedures for most surgeons. However, Dr. Kridel has written and published scientific papers on how to combine perforation repair with a rhinoplasty or revision rhinoplasty successfully. However, the primary goal of the surgery should be to fix the perforation and only do those cosmetic changes that will not compromise or endanger that closure.

During your consultation, we will be happy to show you before and after photos of patients that had combined procedures completed by Dr. Kridel.

When a perforation is small there is rarely any change from the pre-operative nasal appearance to the post-operative appearance. However, as the size of the perforation increases and the edges are brought together, the end of the nose can possibly rotate up a bit. If the perforation is large, reducing the size of the nose can actually provide more tissue for closure of the perforation.