The independent septal perforation guide
A septal perforation can be repaired.
Understand it, ease it, choose your technique and your surgeon.
Where are you at?
Understand
What a perforation is
An opening that goes right through the septum and connects both nostrils. Air swirls, the lining dries out, crusts form at the rim: that circle is what makes it grow.
What happens
Four sizes
2026 consensus classificationTap a size to see it on the septum.
Crusts, bleeding, dryness. To close it, what counts is the mucosa available around the hole, and its height.
Three positions
Side view of the septum- 1At the frontThe most common and most symptomatic: cold air hits the edges directly (dryness, crusting, bleeding, whistling).
- 2At the backCan be less symptomatic: air arrives already warmed and humidified.
- 3Up highCan weaken the nose's support. A nose that starts to sag needs prompt review.
Common causes, one page each: after septoplasty, cocaine, nasal sprays, nose picking. If your nose whistles: whistling nose.
Common myths
Six false sentences patients hear
The medical literature, including the 2026 international consensus, says the opposite.
Care pathway
What to do, in what order
The most common mistake is skipping steps: operating on inflamed mucosa, or choosing a surgeon too quickly.
- 1Get it measured and documented
- 2Find and treat the cause
- 3Local care
- 4Decide: close, plug or soothe
- 5Choose a true specialist
Daily care
What helps, what harms
Care will not close the hole, but it calms the symptoms and prepares the lining for any surgery.
Do
- Saline rinsesmorning and evening
- Moisturising gel or ointmenton the edges of the hole
- Sesame oilbefore bed
- Humidifierat 40% or above
Avoid
- Picking and cotton buds
- Decongestant spraysbanned with a perforation
- Steroid spraysavoid if possible, never towards the septum
- Cotton, packing or prosthesesin the nostril
- Dry airair conditioning, altitude
Top 3 products
out of 17 compared- 1Bepanthen Augen- und NasensalbeOintment
- 2NozoilOil spray
- 3RinopanteinaOintment
Surgery explained
Closure techniques
Whatever its name, a technique does one of three things: plug the hole, slide neighbouring lining across to cover it, or interpose a support between the two faces.
Plug it
A silicone button blocks the hole. Nothing is repaired: it is a foreign body that can become infected and enlarge the perforation.
Advance the mucosa
Neighbouring mucosa is lifted and slid across the hole, on both sides. This is the most common approach; it takes mucosa from inside the nose.
Interpose a scaffold
Fascia, cartilage or a resorbable plate, slipped between the two mucosal layers, which heal over it. Takes almost nothing from the nose.
Surgeons turn these three principles into ten techniques: seven close the hole, two plug or soothe it without closing, one is still experimental.
- Bilateral advancement flaps
- Bipedicled bridge flap
- AEA flap (anterior ethmoidal artery)
- Floor and turbinate flaps
- Temporal fascia and PDS plate
- Fascia lata and costal cartilage
- Pericranial flap
- Septal button
- Perfoplasty
- Regenerative techniques
Real success rates
Success depends above all on who operates
Between an ENT who closes one perforation a year and a centre that closes fifty, the gap is not a few points: it is double.
Directory
Surgeons who actually close perforations
45 practitioners and teams in 12 countries, listed on their publications and volume. None pays to appear.
Red: high-volume centres or major published series.
- Surgeons in Spain
- Surgeons in Germany
- Surgeons in the United Kingdom
- Surgeons in Turkey
- Surgeons in the United States
Support
You are not alone
A moderated international WhatsApp group: experiences, care that works, feedback on surgeons, preparing for an operation. Have a specific question? Start with the FAQ.
Research and outlook
Lab-grown cartilage
Phase I trial in Basel (N-TEC): cartilage grown from the patient's own cells, in 5 patients with 0.5 to 2 cm perforations. Promising, but experimental.
PRP, fat, stem cells
Added to a technique to boost healing. Very low level of evidence: no cell-based approach closes a hole on its own. An accelerator, not a treatment.
2026 international consensus
25 experts from 15 countries agreed on 98% of statements: validated assessment tools (NOSE-Perf), classification by size and position, medical care before any surgery. Finally a basis for comparing results between teams.