Can Stevie Nicks’s Septum be Fixed?: The Large Septal Perforation

About Dr. Jason Hamilton

Jason S. Hamilton, M.D. is the Director of Plastic and Reconstructive Surgery for the Osborne Head and Neck Institute based at Cedar-Sinai Medical Towers. Dr. Hamilton has advanced training in plastic and reconstructive surgical techniques involving the face, head, and neck, and limits his practice to the treatment of these areas exclusively.

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About Dr. Reena Gupta

Dr. Reena Gupta is the Director of the Division of Voice and Laryngology at OHNI. Dr. Gupta has devoted her practice to the care of patients with voice problems. She is board certified in otolaryngology and laryngology and fellowship trained in laryngology, specializing in the care of the professional voice.

With the current Fleetwood Mac tour, much attention has been placed on Stevie Nicks. In interviews over the past decade, including recently, she has admitted to a history of significant cocaine use. She also bemoans its effect, the hole in her septum, that she says one could “pass a belt through.”

stevie nicks nose hole cocaine

Despite how much it bothers her, Nicks has made much of the fact that she cannot get the hole fixed. Is this true? Are some perforations unfixable?

What is the nasal septum?

The nasal septum divides the nose into right and left nasal passages. It is made up of a delicate lining (mucosa), cartilage and paper-thin bone. The septum provides the central support and foundation for the nose.

large septal perforation

The normal septum ensures air flows through the nose gently, passing straight through without turbulence. As air passes through the nose, it is humidified and filtered. Smooth airflow is critical for healthy breathing passages.

What is a septal perforation?

A septal perforation is a hole in the nose (nasal septum). Septal perforations are caused by an injury to the nasal septum. The septum is delicate and easily injured.

septal peroration surgery

Things that can damage the septum include:

  • Nasal fracture or trauma
  • Infection
  • Medication (Afrin, etc)
  • Drug abuse (cocaine, etc)
  • Autoimmune conditions
  • Prior surgery (septoplasty or rhinoplasty)

Can a large perforation be fixed?

Almost all perforations can be fixed. Even the largest ones can be fixed with the advanced techniques currently available. Most surgeons are not aware of these or are not proficient in such techniques. However, finding the right surgeon helps to treat the perforation to avoid future complications.

What can happen if the perforation is not fixed?

There are many complications to a septal perforation, including:

  • Nasal whistling: a sound can be heard while breathing through the nose
  • Nasal congestion: because air does not flow straight back, but rather through the perforation, the nose feels congested
  • Voice change: loss of nasal resonance, important in singers
  • Nasal crusting
  • Instability of the nose: gradual change to appearance of nose

As the perforation expands (which it does even if drug use is stopped), it continues to destabilize the nose until it collapses, causing “saddle nose deformity” which is cosmetically unappealing and significantly restricts the ability to breathe through the nose.

Because the septum is hidden, people often ignore septal perforations. The health and cosmetic risks associated with ignoring a perforation are significant. Before ignoring a perforation, or assuming it is too large to fix, seek consultation with a septal perforation repair expert. Chances are very high that the perforation can be repaired.

For more information about septal perforation treatment, visit: