Septal perforation repair

What is septal perforation repair?

The septum is the wall of cartilage and bone, lined on both sides by a thin membrane, that divides the inside of your nose into two sides. A septal perforation is a hole through this wall. It can be caused by previous nose surgery, injury, picking, cocaine use, some sprays or medicines, infections or inflammatory conditions.

Many perforations cause no symptoms and need no treatment. When they do cause problems, these can include crusting, bleeding, a whistling noise when breathing, a runny or blocked nose, or a feeling that the nose is dry. Septal perforation repair aims to close the hole, usually by moving the nose's own lining across it and adding a tissue graft for support.

Closing a perforation is one of the more difficult operations in nose surgery, and it does not always succeed, especially for larger holes. Some people choose a removable plastic plug (a septal button) instead, or decide to manage symptoms without surgery.

Types & techniques

There isn't one single operation. The right approach depends on you — which is something to discuss with your surgeon.

Options at a glance

These are the main approaches described in this guide. The right option depends on the diagnosis, your goals and what your clinician thinks is safe.

Preparing for your surgery

• See a surgeon experienced specifically in septal perforation repair, as it is a specialised operation.
• Be ready for questions about the cause, including past nose surgery, injury, sprays, medicines and cocaine use, as these affect healing.
• Stop smoking and any nasal cocaine use well before surgery, as both reduce blood supply and the chance of healing.
• Tell your surgeon about all medicines and supplements, especially blood thinners and steroids.
• Expect tests if an underlying inflammatory condition (such as vasculitis) is suspected, as this should be treated first.
• Arrange about one to two weeks off work and a lift home, as you will have a sore, blocked nose.

What happens

The operation is usually done under general anaesthetic. Depending on the size and position of the hole, the surgeon may work entirely through your nostrils with a telescope, or use a small cut across the skin between the nostrils for wider access.

The lining on each side of the septum is carefully lifted and advanced to cover the hole. A graft, such as cartilage or a sheet of tissue lining, is usually placed between the two layers to support healing. Soft splints or dressings are often left inside the nose for a time to protect the repair.

Most people stay either as a day case or for one night. The nose will feel blocked and sore, and you may have splints inside for one to a few weeks before they are removed in clinic.

Is this operation right for me?

A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.

Before you decide

Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.

Anaesthetic choices

The safest option depends on the operation, your health, the facility and your surgeon/anaesthetist. Ask what is planned and why.

The main uncertainty is whether the hole will stay closed. Success is generally better for smaller perforations and worse for larger ones, and it is lower in people who keep smoking or using nasal cocaine, or who have an untreated inflammatory condition. Ask your surgeon, honestly, what the chance of full closure is for the size of your hole, and what the plan is if it does not close.

Published figures to discuss

Reported success rates for septal perforation repair vary widely depending on perforation size, the technique used, the surgeon's experience and patient factors such as smoking. Studies measure success differently, and series are often small, so figures should be treated as a guide rather than a guarantee. Larger perforations consistently close less reliably than smaller ones.

These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.

Recovery — what to expect, and when

Recovery from septal perforation repair takes a couple of weeks for everyday life, but the repair itself heals over months. The nose feels blocked and sore at first, especially while splints are in place.

• A blocked, congested nose, particularly while splints are in place
• Crusting and small amounts of old, dark blood for a few weeks
• Mild discomfort or pressure across the nose and upper teeth
• Gradual improvement in crusting, whistling and bleeding over months

Aftercare

• Use salt-water rinses and any prescribed ointment to keep the lining moist and clear crusts.
• Do not blow your nose hard in the early weeks; dab gently instead.
• Do not pick crusts or remove splints yourself, as this can damage the repair.
• Avoid heavy lifting, straining and strenuous exercise until your surgeon says it is safe.
• Do not smoke or use nasal cocaine, as both can cause the repair to fail.
• Attend the appointment to have splints removed and the repair checked.
• Know who to contact for heavy bleeding or signs of infection.

• Salt-water spray or rinse pots and any prescribed ointment
• Time off work booked (about 1–2 weeks)
• Lift home arranged after general anaesthetic
• Awareness that splints stay in for one to a few weeks
• Plan to avoid smoking and nasal cocaine completely
• Clinic's contact number saved for bleeding or concerns

Scars and how they heal

If an open approach is used, there is a small cut across the skin between the nostrils that usually heals to a fine, discreet scar. Many repairs are done through the nostrils with no external scar at all. Inside the nose, healing can leave areas of scar tissue, which is part of how the hole closes.

⚠ Get urgent help if…

• Heavy bleeding from the nose that does not stop with gentle pressure
• Spreading redness, swelling or severe pain over the nose or face
• High temperature, feeling generally unwell or thick foul-smelling discharge (possible infection)
• Sudden change in the shape of the nose or the bridge dropping
• A severe headache, neck stiffness or vision changes (seek urgent help)
• Clear watery fluid dripping steadily from the nose after surgery

Who to contact: your surgeon or clinic first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.

General guidance — it doesn't replace the specific advice your surgeon gives you.

Results & realistic expectations

A good result is a hole that stays closed, with less crusting, bleeding and whistling and easier breathing. Symptoms often improve over weeks, but the surgeon usually waits a few months before judging whether closure has fully succeeded.

Success depends heavily on the size of the perforation and on healing factors such as smoking, nasal cocaine use and any underlying condition. Smaller perforations close more reliably than larger ones, and a repair can sometimes reopen. If full closure is not achieved, a septal button or ongoing nasal care may still control symptoms.

Once a repair has fully healed and the hole has closed, the result is usually lasting, provided the original cause is controlled. Continued smoking, nasal cocaine use or an untreated inflammatory condition can cause the perforation to return. Keeping the nose moist and avoiding irritants helps protect the result.

Combining with other procedures

Septal perforation repair is sometimes combined with straightening a bent septum or improving the airway in the same operation. If an inflammatory condition or infection caused the perforation, treating that condition is an essential part of care, not an optional extra.

Follow-up & long-term care

You will be seen to remove splints and check healing, with further reviews over the following months to judge whether the hole has closed. Report heavy bleeding, severe pain or signs of infection straight away.

• Keep the nose moist with salt-water rinses or ointment if advised.
• Avoid smoking and nasal cocaine completely to protect the repair.
• Continue treatment for any underlying condition that caused the perforation.
• Return for review if crusting, bleeding or whistling come back.

Revision and secondary surgery reality

• A perforation can reopen (reperforate), particularly if it was large or the cause is not controlled.
• Repeat surgery is harder than the first attempt because of scarring and reduced lining.
• If repair fails or is not advised, a septal button or ongoing nasal care may control symptoms instead.

Ask your surgeon for their own revision rate, what counts as a revision, and what is included in the written aftercare policy.

What good aftercare looks like

• Clear advice on nasal rinses, not picking crusts and not removing splints yourself.
• A named contact for heavy bleeding or signs of infection.
• Planned reviews over several months to judge whether the hole has closed.
• Support to stop smoking and nasal cocaine use, and treatment of any underlying condition.

What affects the cost

Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:

• The size and position of the perforation and how difficult it is to close
• Whether the repair is endoscopic or uses an open approach
• Surgeon, anaesthetist and theatre or facility fees
• Any tests to look for an underlying inflammatory condition
• Whether a septal button is fitted instead of, or alongside, surgery
• Follow-up appointments, splint removal and any repeat surgery if it does not close

• The surgeon's fee and the planned technique
• Anaesthetist and theatre or facility fees
• Cost of grafts, splints or a septal button if used
• Follow-up appointments and splint removal
• Who to contact for bleeding or complications
• What happens, and what it costs, if the repair does not close

On the NHS? Septal perforation repair is available on the NHS when a perforation causes troublesome symptoms; private care may be used for speed, choice or a second opinion, and criteria vary by area.

You're entitled to your total cost in writing — including aftercare and any revision — before you decide.

Consent traps and marketing red flags

These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.

Choosing a surgeon safely

• Check your surgeon is on the GMC Specialist Register for this area.
• Make sure they practise at a CQC-registered location, and look for membership of bodies like BAAPS or BAPRAS.
• You're entitled to a two-stage consent process with time to reflect (a cooling-off period). The surgeon who will operate must consent you — not a salesperson.
• Be wary of pressure: time-limited offers, discounts or deposits taken before you've had time to think are red flags, not bargains.
• You're entitled to your total cost in writing — including aftercare and any revision — before you decide.

How Vuemedics verifies every consultant →

Take this to your consultation. A good surgeon will welcome every one of these.

• What size is my perforation, and what is the chance it will fully close?
• What caused my perforation, and does anything need treating first?
• Which technique would you use, and will there be any external scar?
• What is the plan if the repair does not close — would a septal button help?
• How long will splints stay in, and what should I avoid while healing?
• Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
• Will you be the surgeon who carries out my operation, and who looks after me afterwards?
• What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
• What does a realistic result look like — and what can this operation not achieve?
• What are my options, including waiting, doing nothing for now, or choosing a different approach?
• Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
• What is the total cost in writing, including any follow-ups, and how much time do I have to decide?

Find a verified surgeon for septal perforation repair

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How we made this page

Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →

Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.

Sources & standards: ENT UK — Patient information leaflets NHS — Non-allergic rhinitis (nasal care and symptoms) Endoscopic repair of nasal septal perforation — PMC Surgical treatment of nasal septal perforations — PMC Realistic success rates after septal perforation closure — ScienceDirect

Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.

Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.