context: You look at your nasal septum every time you glance in the mirror. Well, the front of it, anyway. It's what divides your left nostril from your right. And it runs all the way up the inside of your nose. It's made of cartilage in the front and bone in the back. If it's perforated, that means you have a hole through part of it. It opens a path from one side of your nose to the other. A perforated septum doesn't always cause any symptoms, but they can include nosebleeds, trouble breathing, and the feeling that your nose is blocked up. You might make a whistling sound as you breathe. About half the time, this happens after you've had surgery to fix a different problem in your nose. Other causes include: Cautery, a treatment for nosebleeds Certain diseases, including lupus, some cancers, syphilis, and tuberculosis Damage to your nose, like breaking it or even from picking it too much Infections Using drugs that go into your nose too often, ranging from over-the-counter nasal sprays to cocaine Surgery can sometimes fix a perforated septum, but it doesn't always work, and it's not always needed. In general, small holes are easier to fix than larger ones. The procedure takes 1 to 3 hours, and you typically go home the same day. Usually, you get drugs to help you sleep through it. Some doctors use closed surgery, which means they go in through the opening in your nostrils. Others open up your nose for better access. There are all kinds of ways to do the fix. Your doctor will choose one based on where the hole is and how big it is, as well as his skills and experience. Typically, he'll take tissue from your nose, or even your mouth, to cover the hole. Then he'll put a flap of new tissue on each side of the hole. Some doctors think that's all you need, while others add more support with bone, cartilage, or tissue from other parts of your body. You'll likely have thin splints in your nose to cover and protect the flaps. They'll stay in for a week or two. To protect your nose as it heals, it's best to: Not lift heavy things or bend over Not pick your nose or blow it too hard Rinse with saline as often as your doctor tells you to Sneeze with your mouth open Stay away from contact sports Most of the time, you'll feel back to normal within a few weeks. You'll probably have a follow-up visit a week after surgery. Your doctor will: Check the splints and may take them out Clean out your nose if you have any crusting Make sure you're healing well You might have another checkup at 2 weeks, then maybe at 6 and 12 weeks out. You usually know if it worked after 6 weeks. As with any surgery, you need to keep a close eye on things as you heal. Call your doctor if you have: Bleeding Fever Lots of fluid draining from your nose Pain and swelling that get worse Redness on the outside of your nose Trouble breathing Surgery isn't usually the first step in treatment. Your doctor may suggest an ointment or a regular saline rinse. If those ease your symptoms, you still need to go for regular checkups because the hole could grow. If it gets too big, your nose won't be as stable, and that may make the tip or middle of your nose start to droop. If those don't work, your doctor might look for other problems in your nose, especially if your main symptom is that you feel a blockage. That could be caused by something else, and surgery may not help. You also need to understand what led to the hole. If it was caused by an ongoing issue, like a tumor, infection, or drug use, your doctor should treat that first. Then you can think about care for your septum.