About the Procedure
A nasal septal perforation is a hole through the septum, the wall of cartilage and bone that divides the two sides of the nose. Perforations can follow prior nasal surgery, trauma, certain nasal sprays or medications, drug use, chronic inflammation, or specific medical conditions, and some have no identifiable cause.
Symptoms may include crusting, recurrent nosebleeds, a whistling sound when breathing, congestion, and discomfort. Surgery aims to close the perforation and restore a healthy, intact lining so these symptoms improve.
At Norelle Health, evaluation includes examination, nasal endoscopy, and a search for an underlying cause. Repair is individualized to the size and location of the perforation, and not every perforation requires or is suited to surgery.
Who may be a candidate
Repair may be considered when a perforation causes bothersome symptoms and the surrounding tissue is suitable for closure. It is often most successful for small to moderate perforations with adequate healthy lining.
Not everyone is a candidate. Larger perforations, those caused by active inflammation or ongoing irritation, and certain medical conditions may be better managed with a removable septal button or with medical care first. Identifying and controlling the cause is an important part of planning.
Considering nasal septal perforation surgery? The next step is a quiet, unhurried conversation.
How it is performed
Surgery is usually performed through the nostrils, sometimes with an endoscopic or open approach depending on the perforation. The surgeon mobilizes the nasal lining on both sides to close the hole and often places a tissue graft, such as cartilage or connective tissue, between the layers to support healing.
The goal is to bring healthy lining together over a stable framework so the repair has the best chance to heal. Temporary splints may be placed to protect the work while it heals.
Recovery and aftercare
Expect nasal congestion, crusting, and the need for regular saline rinses while the lining heals. Splints or dressings are sometimes left in place temporarily and removed at a follow-up visit.
Heavy lifting, straining, and nose blowing are usually limited for a period to protect the repair. Breathing and crusting tend to improve gradually over weeks, and follow-up visits monitor how the lining is healing.
Risks and alternatives
Possible risks include bleeding, infection, crusting, incomplete closure or recurrence of the perforation, changes in nasal shape or breathing, and the need for further treatment. Because healing depends on the tissue and the underlying cause, closure is not guaranteed.
Alternatives include a removable septal button that covers the hole, medical measures such as saline, humidification, and ointments to reduce crusting and bleeding, and treating any underlying condition or irritant. Some small, minimally symptomatic perforations may simply be observed.
Results and follow-up
When the perforation closes, many people notice less crusting, bleeding, and whistling and a more comfortable nose. Results depend on the size of the perforation and the health of the lining.
Follow-up confirms healing and addresses any residual symptoms. If a perforation does not fully close, a button or additional treatment can be considered.
Clinical references
Medical review
This page is a patient-education resource reviewed by the responsible Norelle Health clinician before publication. It does not replace an in-person evaluation. If symptoms are severe or rapidly worsening, seek immediate medical care.
Specialists who perform nasal septal perforation surgery
Dr. Moustafa Mourad
MD, FACS
Double Board-Certified Head & Neck and Facial Plastic & Reconstructive Surgeon
Dr. Moustafa Mourad is a double board-certified head and neck and facial plastic and reconstructive surgeon who cares for the full range of cosmetic and complex conditions affecting the face, head, and neck.
- Facial plastic and reconstructive surgery
- Head and neck cancer surgery
- Microvascular free-flap reconstruction
- Facial trauma and reconstruction
Also caring for this area
Not sure who to see? Our patient coordination team can help match you with the right specialist.
(212) 444-8006Frequently Asked Questions
It is a hole through the septum, the cartilage-and-bone wall dividing the two sides of the nose. It can cause crusting, nosebleeds, a whistling sound, congestion, and discomfort.
Common causes include prior nasal surgery, trauma, certain nasal sprays or medications, drug use, chronic inflammation, and some medical conditions. In some cases no clear cause is found, which is why evaluation includes a search for an underlying problem.
No. Small or minimally symptomatic perforations may be managed with saline, humidification, and ointments, or with a removable septal button. Surgery is considered when symptoms are bothersome and the tissue is suitable for closure.
A septal button is a soft, removable device that fits into the perforation to cover the hole and reduce crusting, bleeding, and whistling. It can be an alternative to surgery, especially for larger perforations.
Repair is usually performed through the nostrils. Depending on the perforation, an endoscopic or open approach may be used, and a graft is often placed between the lining layers to support healing.
Expect congestion, crusting, and saline rinses while the lining heals, sometimes with temporary splints. Nose blowing and strenuous activity are limited for a period to protect the repair, and symptoms improve gradually over weeks.
Closure is not guaranteed. Success depends on the size and location of the perforation and the health of the lining. If it does not fully close, a button or additional treatment can be considered.
If an irritant, medication, or active inflammation contributed to the perforation, addressing it improves the chance of healing and lowers the risk of recurrence after repair.
Related Conditions
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