Septal perforations, a hole in the wall that separates your nostrils, can happen for many reasons. While recent reports mention that Paris Jackson has a perforated septum, it’s a reminder that this condition isn’t rare and isn’t always from drugs. Common causes include chronic nose picking, long-term decongestant spray use, trauma, previous nasal surgery, septal piercings, autoimmune conditions, and yes, inhaling drugs like cocaine, which can damage blood supply inside the nose. Prevention tips: