Septal Perforation Repair: My Approach

Septal perforations — holes in the cartilage and tissue that divide the nose — can cause a wide range of symptoms that impact both comfort and quality of life. Some patients experience whistling, crusting, bleeding, or dryness. Others develop nasal obstruction, difficulty breathing, or even cosmetic changes to the nose over time.

Many people don’t realize that septal perforation repair is possible, or that it can often be performed at the same time as a rhinoplasty. The key is using a reliable technique that restores structure and stability.

In my practice, I repair septal perforations using a temporalis fascia graft combined with a PDS plate, a technique that has proven extremely effective for both small and large perforations — including those up to 2.5 cm or more in diameter.

My success rate with this method is over 90%, and this approach allows me to address both function and aesthetics during the same operation.

What Is a Septal Perforation?

A septal perforation is a hole in the nasal septum — the wall of cartilage and mucosa that separates the two nasal passages.

Common symptoms include:

• whistling when breathing

• crusting

• bleeding

• dryness

• chronic irritation

• nasal obstruction

• decreased airflow

• recurrent infections

• saddle nose deformity (in advanced cases)

Common causes include:

• prior septoplasty or rhinoplasty

• trauma

• chronic nasal picking

• infection

• autoimmune conditions

• previous cautery

• intranasal drug use

Not all perforations need repair, but those causing symptoms often benefit significantly.

Why Perforation Repair Is Challenging

Closing a septal perforation was difficult in the past because the tissue around the hole has reduced blood supply. Repairs fail when grafts or flaps don’t get enough vascular support. PDS plate and fascia simplified the repair and made it more predictable.

The goal of any successful repair is to:

• recreate mucosal lining on both sides

• restore structural separation

• promote robust healing

• stabilize the septum long-term

• prevent recurrent breakdown

This is why I use a technique that reinforces both sides of the perforation and provides a scaffold for new tissue to grow across the defect.

My Preferred Method: Temporalis Fascia + PDS Plate

This is the technique I use because it is stable, predictable, and highly successful — even in larger perforations.

What each component does:

🟦 Temporalis fascia

This is a thin, vascularized tissue layer taken from a small incision above the ear.
It is:

• strong

• flexible

• highly biocompatible

• ideal for lining the septum

Temporalis fascia is frequently used in ear and nasal reconstruction because it integrates beautifully with surrounding tissue.

🟪 PDS Plate

PDS (polydioxanone) is a dissolvable material that acts as a structural scaffold.
When paired with fascia, it:

• provides strength

• stabilizes the repair

• maintains the contour

• supports mucosal regeneration

• dissolves over months as healing completes

The combination allows the body’s tissues to grow across the perforation in a tension-free, stable environment.

What Size Perforations Can I Repair?

Using this method, I am routinely able to close perforations up to 2.5 cm or larger, depending on:

• mucosal quality

• blood supply

• whether the patient is undergoing rhinoplasty simultaneously

• presence of inflammation or crusting

• structural integrity of surrounding cartilage

Larger perforations require careful planning, but they can be successful when properly supported.

Can This Be Performed During Rhinoplasty?

Yes — and this is one of the most valuable parts of this technique.

When combined with rhinoplasty:

• I can restore structure

• improve breathing

• reinforce the septum

• support the tip

• correct functional issues

• enhance aesthetics in the same operation

Septal perforation repair adds approximately one additional hour to rhinoplasty surgery, depending on the size and complexity.

Success Rate

Using this approach, my success rate is greater than 90%, which is significantly higher than many traditional mucosal flap techniques alone.

Key reasons for the high success rate:

• double-layered repair

• strong structural scaffold

• excellent tissue integration

• controlled environment during rhinoplasty

• improved blood supply after correcting septal deviations

• careful postoperative management

What Patients Can Expect After Perforation Repair

Recovery includes:

• nasal splints (temporary)

• saline sprays

• humidification

• avoiding trauma or nose blowing

• follow-up visits to monitor healing

Most patients experience a significant reduction or complete resolution of their symptoms once the perforation heals.

Who Is a Good Candidate?

You may benefit from perforation repair if you have:

• breathing difficulties

• crusting or dryness

• bleeding

• whistling

• nasal obstruction

• structural weakness

• visible deformity

• discomfort

• perforation discovered during evaluation for rhinoplasty

Not all perforations require closure, but symptomatic ones often do.

Why Technique Selection Matters

Many perforation repairs fail because:

• the grafts are not supported

• the tissues are under tension

• blood supply is inadequate

• the repair is too thin or fragile

Temporalis fascia + PDS plate provides:

• strength

• vascular integration

• stability

• long-term durability

It’s one of the most reliable methods for closing larger defects.

Bottom Line

Septal perforations can cause frustrating symptoms — but modern techniques have made closure consistently successful. Using a combination of temporalis fascia and a PDS plate, I’m able to repair perforations up to 2.5 cm+ with a success rate over 90%, often performed safely during rhinoplasty.

If you’re considering rhinoplasty or dealing with a septal perforation, there are excellent treatment options available, and a carefully planned structural repair can dramatically improve both function and quality of life.