Prof. Dr. Gediz Murat Serin – Ear, Nose and Throat Specialist
Holes in the nasal septum are commonly called nasal holes, and medically referred to as septal perforation. Repairing this hole is one of the most difficult and delicate operations in nasal surgery. If this hole has been previously operated on but could not be closed — meaning a revision septal perforation is involved — the surgery becomes much more difficult both technically and biologically.
Because in this case, there is not just a hole; there is tissue that has been previously exposed to surgery, has reduced blood supply and impaired healing capacity.
In this article, I want to explain in simple and understandable terms what revision septal perforation repair is, why it is difficult, who it is suitable for, in which situations the risk increases, and what should be considered.
What is Revision Septal Perforation?
Revision septal perforation is the second or subsequent repair surgery performed for nasal holes that have been previously attempted to be closed surgically but have reopened or never closed at all.
In such cases, the problem is often not the hole itself, but that the tissue around the hole is no longer healthy.
Why is Revision More Difficult?
Because in revision cases generally:
- The tissue has been previously cut, moved or stretched.
- Its blood supply has been impaired.
- Permanent sutures or rigid materials may have been left inside.
- The nasal skeleton may have weakened or collapsed.
Therefore, each revision case is evaluated separately; there is no standard surgery.
What is Considered When Making the Surgery Decision?
When planning revision septal perforation repair, the following factors are definitely evaluated:
- Location of the hole (anterior, posterior, superior, inferior),
- Quality and vitality of the surrounding tissue,
- How many times surgery has been performed previously,
- Whether a flap (tissue advancement) was performed previously,
- Whether grafts or permanent sutures were placed inside,
- History of smoking and substance use.
Particularly perforations located in the anterior-superior region are more risky both functionally and aesthetically.
Why are Substance Use and Smoking Important?
Substances inhaled through the nose (especially cocaine) directly destroy the mucosa, constrict blood vessels and prevent healing. Smoking similarly impairs tissue blood supply.
If these habits continue, no surgery performed will be permanent. This is a biological failure, not a technical one.
Is it Always Done from Inside the Nose?
No. In some cases, working only from inside the nose is not sufficient. Especially when:
- Tissue is insufficient,
- Nasal support has collapsed,
- There is simultaneous nasal deformity,
- Safe access to the anterior-superior region is needed,
it may be necessary to work by also opening the nose from the outside. This is not for aesthetic purposes; it is to solve the problem safely, in a controlled manner and permanently.
Who is Revision Septal Perforation Surgery Suitable For?
- Patients with significant complaints,
- Those whose tissue condition is suitable for surgery,
- Those who have stopped substance use,
- Non-smokers or those who have quit,
- Patients with realistic expectations.
Conclusion
Revision septal perforation repair:
- Is not a standard surgery,
- Cannot be applied the same way to everyone,
- Requires experience, planning and correct patient selection.
Therefore, it is very important that this surgery is planned in centers that specifically work on this subject and have experience.
About Me
Prof. Dr. Gediz Murat Serin is an Ear, Nose and Throat and Head-Neck Surgery specialist. He particularly works on septal perforation repair, revision nasal surgery and functional nasal problems. In his clinical practice, he applies multilayer repair techniques and personalized surgical planning in perforation repairs.
Frequently Asked Questions
1-Does this surgery definitely close the hole?
Unfortunately, it is not possible to guarantee success in every case. In revision cases, success depends on tissue quality and patient compliance.
2-Why is revision surgery more difficult?
Because the tissue has been previously damaged and healing capacity has decreased.
3-Is the surgery performed on everyone?
No. It is not recommended for those with active substance use or if the tissue is severely damaged.
4-How long does the surgery take?
It generally takes 3-4 hours.
5-Is there pain?
It is generally mild and controllable.
6-Is hospitalization required?
Most of the time, 1 night is sufficient.
7-How long does healing take?
Initial healing takes 2-3 weeks, full healing takes 3-6 months.
8-When can I return to work?
Generally within 7-10 days.
9-Is this cosmetic surgery?
No, it is a functional surgery.
