Long-term Results of Combined Rhinoplasty and Septal Perforation Repair

Hong SN, Mutsumay S, Jin HR.

What this paper says

In 17 patients who had a hole in the nasal septum closed at the same time as rhinoplasty, 15 of 17 (88%) had complete closure with symptom relief over a mean follow-up of 50.9 months.

Overview

A hole through the wall dividing the two sides of the nose can cause blockage, crusting, nosebleeds and whistling, and it often coexists with a collapsed or crooked nose. This retrospective review at one tertiary academic center asked whether closing that hole and reshaping the nose in the same operation works over the long term. Patients treated between March 2005 and March 2015 were analyzed.

Sections of note

17 patients: 14 men, 3 women, mean age 40 years (SD 16); mean follow-up 50.9 months.
Cause of the perforation: 12 (71%) previous septoplasty or septorhinoplasty, 4 (24%) nasal trauma, 1 (6%) unknown.
Aesthetic reasons for rhinoplasty: saddle nose in 10 (59%), deviated nose in 5 (29%).
Functional complaints: obstruction 14 (82%), crusting 2 (12%), nosebleed 1 (6%), whistling 1 (6%).
Perforation size 2 to 30 mm, mean 14.3 mm; all done through the open rhinoplasty approach.
Closure used advancement flap in 6, rotation flap in 6, both in 4, and advancement flap plus free mucosal graft in 1.
Complete closure with symptom relief in 15 of 17 (88%); mean Objective Rhinoplasty Outcome Score 3.4 out of 4; no serious complications. Level of evidence 4.

What it means for a patient

Combining the two operations avoided a second surgery for most patients here, and the cosmetic result was rated good to excellent on average.
Most perforations in this group followed earlier nasal surgery.
Limits: only 17 patients, one center, retrospective, no comparison group doing the operations separately.
Satisfaction was collected by telephone survey, which can favor more positive answers.

Why this paper matters

Surgeons have debated whether repairing a perforation compromises the cosmetic result or the reverse. This series reports that the repair did not degrade the rhinoplasty outcome. The sample is too small to define which perforation sizes or flap choices do best.

Terms

Nasal septum: The wall of cartilage and bone between the two nostrils.
Septal perforation: A hole through that wall.
Saddle nose: A nose whose bridge has collapsed downward.
Open rhinoplasty: An approach using a small cut across the columella so the framework is seen directly.
Advancement flap: Local lining tissue slid over to cover a defect.

Summary written by rhinoplasty.cc from the abstract, 2026-09-09; not medical advice. The authors' own abstract follows.

From the abstract

“Combined rhinoplasty and septal perforation repair is a technically challenging procedure, and few studies have reported the outcomes. Objective: To present the long-term surgical results of rhinoplasty with concurrent septal perforation repair. Design, Setting, And Participants: This retrospective study included 17…”

Excerpt; the full abstract is on PubMed.