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Case Study 11: Revision Septorhinoplasty and Septal Perforation Closure for Breathing and Shape

Nov 16, 2023
3 min read

Updated: Oct 3

Case summary

  • Patient: 43-year-old woman from Turkey

  • Procedures: revision septorhinoplasty, septal perforation closure

  • Surgeon: Prof. Dr. Suleyman Tas, Prof. Dr. Suleyman Tas Clinic, Istanbul

  • Goal: comfortable nasal breathing and a nose without a hump or droopy tip

Case Study 11: Revision Septorhinoplasty and Septal Perforation Closure for Breathing and Shape

The patient's concerns

This patient had previously undergone septoplasty and rhinoplasty. Years later she still struggled with breathing, and her nose had a dorsal hump and a droopy tip. Examination also revealed a hole in her nasal septum, a septal perforation, which can cause crusting, nosebleeds, a whistling sound and a feeling of blockage.

What is a septal perforation?

The septum is the wall of cartilage and bone that divides the nose into two passages. A perforation is a hole through it. Common causes include previous septal surgery, trauma, nose picking, chronic use of certain nasal sprays and some medical conditions. Small perforations may cause no symptoms, but larger ones disturb airflow and dry the lining, leading to crusts and bleeding. Losing septal support can also let the nose collapse over time.

What was done

Revision septorhinoplasty

In a revision septorhinoplasty the functional and aesthetic problems left after earlier surgery are corrected together. The remaining septal deviation was straightened to open the airway, the dorsal hump was removed, and the droopy tip was supported and lifted so it no longer sagged when smiling. Because previous surgery often removes septal cartilage, grafts may be taken from the ear or rib to provide strong support. Read more about revision rhinoplasty.

Septal perforation closure

The perforation was repaired by moving well-vascularised lining (mucosal flaps) from inside the nose to cover the defect, supported by an interposition graft between the layers when needed. Closing the hole restores smooth airflow and stops crusting and bleeding, and it also reinforces septal support for the rhinoplasty.

Result

The patient's breathing improved and her profile became smoother, with the hump removed and the tip lifted and supported, a combined functional and aesthetic success.

Recovery

Internal silicone splints protect the repair and are usually removed after one to two weeks. Saline irrigation and ointment keep the lining moist during healing. Swelling settles over months, as with any revision rhinoplasty.

Frequently asked questions

Can every septal perforation be closed?

Success depends on size, location and tissue quality; many perforations can be closed or significantly reduced.

Why do breathing problems persist after septoplasty?

Residual deviation, nasal valve collapse, turbinate enlargement or a perforation can all be responsible; each needs to be diagnosed.

Is revision septorhinoplasty covered by insurance?

The functional part may be covered in some systems; the aesthetic part usually is not.

Next step

Read about nasal valve collapse, browse the case studies page, or contact Prof. Dr. Suleyman Tas Clinic for an assessment by Prof. Dr. Suleyman Tas.

How soon can I go back to work after nose surgery?

Most patients return to desk work once the cast is removed at about a week, when the swelling and bruising around the eyes have largely faded.

Will my result look like this one?

Every nose starts from different anatomy — skin thickness, cartilage strength and any previous surgery change what is achievable. A case shows what was possible for that patient, not a promise for every nose.

When can I exercise after nose surgery?

Light walking in the first week, gentle cardio after three to four weeks, and contact sports or anything that risks a blow to the nose only after about three months.

About the author

Prof. Dr. Suleyman Tas is a European Board-certified plastic, reconstructive and aesthetic surgeon based in Istanbul with over 20 years of experience, author of Rhinoplasty in Practice (CRC Press) and founder of the Closed Atraumatic Rhinoplasty Course. Read verified patient reviews or book a consultation.

This article is for general information and does not replace an individual medical consultation.

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