The Nose Knows: 5 Questions to Ask Before a Septum Piercing

If you're into body art, you might have considered piercing your septum — that delicate piece of cartilage in the middle of your nose that divides your nostrils. But the first, and most important, thing you need to know, is that it should be done by an experienced piercer who understands anatomy, according to Dr. Monica Kieu, a double-board certified otolaryngologist (ENT surgeon) and facial plastic surgeon who practices in Beverly Hills and Newport Beach, California. "Everything should be carefully sterilized," she says, via email, "and safety precautions should be in place to prevent COVID or other infections."

Septum piercing has been a worldwide symbol of beauty and a rite of passage in many cultures —including those of the aboriginal people of Australia, the ancient Mayans and Native Americans — and still is popular today, as evidenced by celebrities from Lady Gaga to Rihanna, says Kieu. But as popular as it is, septum piercing doesn't come without some inherent risks. Here are five questions to investigate and keep top of mind if you are thinking about undergoing this facial piercing procedure.

1. So, What Exactly Is the Septum?

The septum is the part of your nose that makes up the dividing wall between the two nostrils, or nares, according to Dr. Vivian Ting, chair of John Muir Medical Center's division of plastic surgery in Walnut Creek, California. There are three components of the septum, says Ting, in an email interview. They include the membranous septum, or the fleshy part just inside the nostril opening (which is where septal piercings are performed); the cartilaginous septum, which forms the firm yet pliable part of the septum; and the bony septum, consisting of the ethmoid and vomer bones, which is the rigid portion of the septum attached to the facial skeleton. "The septum is lined by a thin layer of tissue on either side called the mucosa," she adds, "which helps to warm the air and produces mucus that lubricates the nostrils and is important in trapping foreign material, bacteria and viruses."

2. What Does the Process Involve?

While there can be some variation in method, septum piercings are done in much the same way ear piercings are done. The practitioner will clean the intended area before using a small clamp to hold the septum. The piercer will then pass a hollow needle attached to a tube, known as a cannula, through the septum, before inserting the jewelry of choice through the new hole. After the jewelry is secured, the piercing is complete.

You can get your nose pierced on the nares, which are the fleshy, cartilaginous skin around the nostrils, but a septum piercing is slightly different due to the position of the piercing between the nostrils. Although it's called a "septum" piercing, the needle doesn't go through the septal cartilage. "Instead," says Kieu, "it pierces the soft part of skin just in front and below it." She recommends avoiding nickel-based jewelry, which can cause allergic reactions in many people. "Surgical stainless-steel is the safest, since it is hypoallergenic," she says.

3. Does Septum Piercing Hurt?

The pain feels like a sharp prick that goes away quickly, according to Kieu. "You may feel some soreness in the area for up to six to eight weeks," she says. "As with the rest of your body, it can take up to a year for wounds to fully heal and for scar tissue to form."

4. What Should I Expect Following a Septum Piercing?

It's normal to experience some swelling and soreness after the piercing. "Your piercer will give you after-care instructions," says Kieu. "Keeping it clean with saline and ointment will help it heal, and most importantly, resist the urge to pick or play with it!"

Ting cautions that if you develop any continued bleeding, fever, chills, foul drainage or redness of the nasal skin, you should go to an emergency room immediately and be evaluated by a board-certified plastic surgeon or otorhinolaryngologist (an ear, nose and throat doctor). "Consider reducing the amount of bacteria colonizing your nose prior to the piercing procedure by applying mupirocin ointment inside each nostril twice daily for a week with a cotton swab to reduce staph," she says. Compared to over-the-counter (OTC) first aid topical antibiotics, mupirocin (Bactroban) can kill a larger variety of bacteria and is a good alternative if you're allergic to certain ingredients in OTC products. Bacitracin and Neosporin are both OTC topical antibiotic alternatives.

5. What Are the Risks?

Infection is the most common complication after a piercing, according to Kieu. "Some important signs to look for are pain, significant swelling, redness or pus draining from the area," she says. "Granulation tissue is a type of inflammatory tissue that will look like a large bump in the area of the piercing; it is typically not painful, but may need to be removed by a doctor."

According to Ting, only the soft tissue at the end of the septum should be used for piercing, as is the case for ears as well. "Never allow anyone to pierce the cartilage of the septum," she says. "An infection of the cartilage could be disastrous. Cartilage is avascular (meaning it has a poor blood supply), so a bacterial infection could be difficult to clear. The nose is a potential site for harboring methicillin-resistant staphylococcus aureus (MRSA) and an infection with MRSA could be resistant to many antibiotics. Toxic shock (bacterial sepsis with staphylococcus or streptococcus organisms) can originate in the nose and lead to life-threatening systemic illness. If a hole is created in the cartilaginous septum and becomes too large, air can pass between the nostrils during exhalation. This perforated septum creates a whistling sound, often associated with patients who inhale cocaine or methamphetamine."

In addition, says Ting, catching a piercing on clothing can be pretty painful and lead to rips, which may be difficult to reconstruct and may result in distortion of the columella, or the skin bridge at the end of the nose between the nostrils. "Tears or perforations of the septal cartilage are even more challenging to repair than in the membranous septum, so never pierce the cartilage," she adds.

Now That's Interesting

All noses are different, which means septum piercing might not be perfect for some people. For instance, not everyone's septum has a columella, which is the thin strip of fleshy tissue that sits in front of the cartilage, according to Healthline. Ideally, that bit of flesh is the "sweet spot" that piercers use for septum piercings. If you have one that is particularly thin or nonexistent, a piercer could go through the cartilage, but that will hurt and take longer to heal. And if you have a deviated septum, your piercing won't be centered, which can be a big deal for some folks.