This may be brought on directly, as in the case of nasal piercings, or indirectly, as by long-term cocaine use or chronic epistaxis. Rhinoplasty, if performed improperly, often results in a perforated or collapsed septum. Reasons for perforated nasal septums include constant manipulations, or rheumatologic diseases such as Wegener's granulomatosis. A perforated septum can result in breathing noises and may lead to recurrent nose bleeds. In this case, the perforation can be closed. The technique most frequently used is the mucosal bridge flap which covers the hole and creates an intact septum.