The question of whether a hole in the nose can heal on its own depends entirely on the nature and location of the defect. A small hole in the soft tissue of the outer nostril, such as from a piercing, heals through the body’s natural wound repair mechanisms. However, a hole in the internal structure of the nose, specifically the nasal septum, involves damage to cartilage. Cartilage is a tissue type with almost no capacity for self-repair, meaning these defects require medical intervention.
Healing Small Holes From Piercings
When a nostril piercing is created, the body initiates a healing process that forms a protective, permanent tunnel of skin cells around the jewelry. This tube-like structure is called a fistula, resulting from epithelial cells migrating along the wound track. A nostril piercing often takes four to six months to fully heal and establish this fistula. If the jewelry is removed prematurely, the small wound usually closes quickly, sometimes in a matter of hours or days.
Once the fistula is fully established, the hole shrinks significantly but does not fully disappear. The body’s natural repair process results in a small, permanent scar or dimple. Complete closure of a long-established piercing requires a minor surgical procedure to excise the mature fistula tissue and suture the skin edges.
Understanding Septal Perforations
A septal perforation is a defect in the nasal septum that will not close naturally and presents a medical concern. The septum is the wall of cartilage and bone dividing the two nasal passages. Perforations involve a loss of the full thickness of the septal structure, including the cartilage and the mucosal lining on both sides. Septal perforations arise from various sources, most commonly localized trauma, previous nasal surgery, or chronic irritation. Causes include repeated nose picking, excessive use of steroid nasal sprays, or the use of inhaled recreational drugs, which can lead to localized tissue death. Symptoms often include a persistent whistling sound when breathing, chronic crusting, dryness, and recurrent nosebleeds.
Why Cartilage Damage Does Not Close Naturally
The reason a septal perforation is a permanent defect is the biological composition of cartilage tissue. Unlike skin and muscle, cartilage is avascular, meaning it lacks a direct blood supply. Cartilage receives nourishment indirectly through diffusion from the surrounding mucosal lining, not from a network of blood vessels. The absence of a dedicated blood supply means the tissue lacks the necessary components—such as immune cells, growth factors, and oxygen—to launch a proper healing response. When septal cartilage is damaged or lost, the body cannot bridge the gap with new cartilage tissue. Instead, the edges of the hole are lined by the surrounding mucosa, leaving the opening permanently exposed unless medical intervention occurs.
Medical Approaches to Repair
Since the perforation will not close on its own, treatment aims either to manage symptoms or surgically repair the defect.
Non-Surgical Management
For patients with minimal symptoms, non-surgical management focuses on improving the nasal environment to reduce crusting and bleeding. This includes regular saline nasal irrigation, humidification, and the application of moisturizing ointments to the edges of the hole. A common non-surgical option is the placement of a septal button, a custom-fitted silicone prosthetic device designed to plug the hole. The button prevents the turbulent airflow that causes crusting and whistling, offering effective symptom relief. This device is reversible and does not require surgery, but it requires periodic cleaning and maintenance by a specialist.
Surgical Repair
Surgical repair is the only way to achieve permanent closure of the defect, often involving the use of mucosal flaps. The surgeon borrows healthy tissue, complete with its blood supply, from an adjacent part of the nasal cavity to cover the hole on both sides. For larger or more complex perforations, a graft of supporting material, such as fascia or cartilage harvested from the ear or rib, may be placed between the two mucosal flaps for structural reinforcement. The success of this surgery depends heavily on the size of the perforation and the condition of the remaining septal tissue.