Septal perforation after septoplasty or rhinoplasty
Previous nasal surgery is the most common cause of a hole in the septum. It is not "normal", it is not your fault, and it can be repaired: why the hole forms, when it is found and what to do, in order.
Written by the Septal Perforation team, patients, from the sources cited · Reviewed by doctors · Updated 1 November 2026 · Method and sources
In brief
A perforation follows 0.5 to 3.1% of septoplasties: it is a recognised complication, not a normal part of recovery.
It forms when the lining is torn on both sides at the same spot, where cartilage has been removed; it is usually found in the weeks after the operation.
Get your operation note, have the hole measured, look after the lining, then have the repair done by a team that closes perforations regularly.
How many septoplasties end with a perforation
Septoplasty straightens a deviated septum and is one of the most common nasal operations. Published series report a perforation after 0.5 to 3.1% of procedures, and around 1% in several large series. Out of a hundred people operated on, one to three leave with a hole in the septum.
That is rare for any one surgeon, but a lot across a country: nasal surgery is the leading cause of perforation found in studies. The 2026 international consensus lists it, with intranasal drug use, as one of the two most common causes.
Rhinoplasty carries the same risk as soon as it involves the septum: harvesting cartilage to support the tip, or straightening it at the same time (septorhinoplasty). The mechanism is identical.
Published range: 0.5 to 3.1%. About one perforated patient in five has no symptoms, which sometimes delays the diagnosis.
Why a hole forms
To straighten the septum, the surgeon lifts the lining off each side of the cartilage, like separating the two faces of an envelope, then removes or repositions the bent part. The lining is what feeds the septum: as long as one side stays intact, the area heals.
Schematic cross-section of the septum seen from above: two linings with cartilage in between. A hole appears when both linings are damaged opposite each other and nothing is left to separate or feed them.
The 2026 consensus describes these perforations separately: they do not follow the slow sequence of dryness, crust and ulcer seen with other causes. They result from cartilage removal combined with tears in both linings. Their edges are often already healed, with no exposed cartilage, and they tend to sit in the middle or back of the septum.
What increases the risk
- 1Tears on both sidesThe main factor: two tears facing each other, especially where the cartilage between them was removed.
- 2Haematoma or infectionBlood or pus collecting against the cartilage cuts off its blood supply; if not drained, it can end in a hole.
- 3Cautery, stitches, splintsHeavy cautery or stitches pulled too tight weaken an area that is already thin.
- 4Smoking and a dry liningAnything that dries or damages the lining during healing works against it; smoking stands out in a series of 400 septoplasties.
When it appears, and how it is noticed
Most post-operative perforations are spotted early, when the splints come out or at the first endoscopic check. Others go unnoticed for months, then show themselves through crusting or a whistle.
A small tear in the lining is common while it is lifted; on one side only, it heals by itself. The surgeon should record it in the operation note.
This is often when the hole is seen. It can also be hidden by healing crusts, which are normal at this stage.
Crusts that keep coming back in the same place, small bleeds, a whistle when breathing in: all reasons to have the septum looked at. An area weakened by a haematoma or infection can open up during this period.
Once the edges have healed, the hole can stay the same for years. Dryness, crusts pulled off and picking can make it bigger instead, which is why it should be measured at every check.
- the septum is painful and swollen and both nostrils block suddenly: this suggests a haematoma, which needs urgent drainage;
- you have a fever, a pus-like discharge or increasing pain: an infection of the septum needs prompt treatment;
- the bridge of the nose sinks: a sign that the cartilage support has been lost.
These situations are rare, but quick treatment can prevent a hole or stop it getting bigger.
You have been told you have a perforation: what to do, in order
- 1Get your recordsOperation note, clinic letters, scan images. You are entitled to them, and the next surgeon will ask for exactly these.
- 2Have the hole measuredLength and height in millimetres, through an endoscope, and its position, front or back. Keep every measurement: it is the only way to know whether it is growing.
- 3Look after the liningRinses, ointment or gel, humidified air, no picking: this is the first-line treatment. Daily care.
- 4Neither rush nor wait for yearsLet the lining heal, then see a surgeon who closes perforations. A hole that grows is harder to close.
- 5Choose who will repair itPerforations after surgery are among the hardest to close: the team's experience matters a great deal. The surgeon directory.
Getting it repaired
A perforation after septoplasty can be closed, but not just anywhere
The 2026 consensus places these holes in the "surgical" category of the House classification: the septum has already been operated on, the tissue planes are scarred and the thinned lining sticks to what is left of the cartilage. They are harder to repair than a perforation in a septum that has never been operated on.
In centres that close many of them, published series still exceed 90% closure; in surveys of ENT surgeons who repair them occasionally, reported rates fall to 40 to 79% depending on size. Every operation uses up lining: the first closure attempt is the most valuable one. Real success rates.
If the shape of the nose has changed too, a drooping tip or a sunken bridge, the consensus recommends correcting everything at the same time. The closure techniques and the surgeon directory will help you prepare for the consultation.
- Does the operation note mention a tear in the lining, on one side or both?
- What are the exact length, height and position of the hole?
- Is there enough cartilage and healthy lining around it for a closure?
- Were my turbinates reduced during the same operation?
- What local care should I do while waiting, and for how long?
- Which team that regularly closes perforations can you refer me to?
Your rights: information, records, compensation
Perforation is a known risk of septoplasty and should be part of the information you were given before the operation. That it happened does not prove negligence: it can occur in good hands. But it is not "normal" either, and you do not have to settle for that answer.
You are entitled to a full copy of your records. In the UK, a subject access request must normally be answered within one month and free of charge; in the United States, HIPAA gives you a right of access within 30 days. Keep copies of everything, including the scan images, before any complaint or claim.
Complaint and compensation routes depend on the country: the NHS complaints procedure in the UK, a medical malpractice claim in the US, the free CCI procedure in France. Time limits apply everywhere, so do not let years go by. See Practical matters.
Frequently asked questions
Can the perforation close by itself?
A tear on one side heals. A hole through both linings does not close on its own once its edges have healed; local care makes it bearable, only surgery closes it.
Should I go back to the surgeon who operated on me?
They should see you and explain what happened, and they hold the operation note and images. For the repair itself, you are free to choose a specialist team: closing a perforation is a different procedure from a septoplasty.
Can rhinoplasty cause a perforation too?
Yes, whenever it involves the septum: harvesting cartilage for the tip or straightening it at the same time. The mechanism is the same, and the closure can be combined with correcting the shape of the nose.
Sources
Every figure on this page comes from one of these publications. The year is the year of publication.
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