Can a perforated septum heal naturally or is surgery the only option? (Photo)

Septal perforations can be bothersome because they can cause crusting, bleeding, and Nadal obstruction.  Unfortunately your septal perforation will not likely heal on its own.  Fortunately, surgery could be an option.  I perform this surgery frequently, usually via incisions placed inside the nose.  You should seek out a surgeon who performs this surgery frequently as ii is quite specialized.  

Thanks for your question. Unfortunately I have never heard of a sepal perforation healing on its own, no matter how small, in fact it is essentially impossible for it to do so. Even more challenging is that large perforations can be very very difficulty to repair surgically. Small perforation can be repaired but still have a fairly high failure rate. Sorry to hear about your issue. I would recommend consulting with an expert nasal surgeon to explore your options. Hope this helps.