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How To Treat Hole In Nose From Cocaine Use?

Hi I'm 21 and I fell into a binge with coke for about 8 months .well just this nov I had scabs and yes I picked them or blew them out, well here comes dec and here comes the scab! I blew the hole thing out!! And I look up there with a flash light and there is a hole , I freaked out I'm very depressed over it and always worring about it, it's not too big but one side is bigger then the other! Please help! I have stopped using also someone please tell me how I can help this close! Thanks!

Doctor Answers (9)

Hole in nose after cocaine use.

+2

First of all you must stay off cocaine. Permanently. It is a potent vasoconstrictor that caused your nasal mucous membranes to die. Your body tried to heal from the alive edges, but more cocaine use killed more tissue (both sides) until the septal cartilage became exposed, dried out, and bacteria dissolved part of it (the part no longer protected by living mucous membranes). Hole results.

Reconstructive nasal surgery can be done, but this is not guaranteed and can fail as well. If even one use of cocaine happens, you might as well not have the surgery as you may cause an even bigger hole, collapse of the entire nose, and then you will really know what "freaked out" means.

I'd suggest professional drug rehab and prolonged and complete drug abstinence (tobacco as well, since nicotine is another major vasoconstrictor) for at least a year before even asking a rhinoplasty expert for surgical repair.

Surgical repair IS possible; the hole will NOT heal on its own (nothing you do or don't do will make a difference here except not making it worse with tobacco or more cocaine). So stay clean, don't pick any scabs that will form, and try to avoid blowing vigorously. Good luck!


Minneapolis Plastic Surgeon
5.0 out of 5 stars 109 reviews

Options in Treating Cocaine Nose Holes

+2

Cocaine has 2 medical uses; it alleviates pain and is a very potent shrinker of blood vessels. As a result it was commonly used in nose surgery to reduce surgical bleeding and pain. Unfortunately it is EXTREMELY addictive and among its victims were many famous people including doctors (Sigmund Freud (father of Pasychoanalysis), William Halstead (father of modern American Surgery) and Sherlock Holmes).

Prolonged application of cocaine causes spasm and stoppage of blood flow in the septum followed by death of the lining followed by creation of various size holes with communication from one side to the other often with whistling on deep breathing. There is NO point in attempting surgery on anyone who is actively still using either cocaine or Neosynephrin. It is highly likely to fail. In such patients, cufflink like rubber prosthesis can be inserted plugging the hole. In others, reconstruction is done by using long flaps of nasal floor and septal lining that are rotated across the hole and stitched in place.

Peter A. Aldea, MD
Memphis Plastic Surgeon
5.0 out of 5 stars 58 reviews

Septal Perforation can be closed

+1
Dear Mish1990,

Let me start by saying that there is no judgement and everyone has regrets...so don't beat yourself up too much over this. A septal perforation can happen even after using cocaine once. It can also happen due to trauma as well as because of a number of different over the counter medications.

The key now is to find a surgeon/ practice, like ours, that specializes in septal perforation repair. Septal perforation repair is a highly specialized procedure and there are actually very few surgeons who have a lot of experience in closing them. Many surgeons will recommend simply placing a plastic septal button. Occasionally this makes sense but depending on the size of the perforation it is very possible to close the hole.

This is done using an open rhinoplasty approach and involves what are called advancement flaps, which basically means that the mucosa around the hole can be released and then brought together to close the hole.

Important not to despair because in the right hands this can be taken care of and no one would ever know that the hole was even there.

Warm Regards,
Peyman Solieman, MD

Peyman Solieman, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 1 review

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Treatment for hole in nose due to cocaine

+1
A septal perforation in the nose is certainly a possibility with cocaine abuse.  This must be diagnosed by a physician, preferably an ear, nose, and throat physician.  Cocaine usage must stop prior to undergoing any reparative procedures.  The simplest procedure involves a silastic septal button, which is inserted and sewn into the perforation under either local or general anesthesia and takes approximately 15 minutes to place.  This will cover the hole and keep airflow from cross ventilating through it.  Cross ventilation through a septal perforation causes crusting, bleeding, and dry air, which creates lots of nosebleeds and whistling.  A small hole can be repaired through traditional surgery.

William Portuese, MD
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Nasal Septal Perforation after Cocaine Use

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This is a very common problem. Fortunately problems from it are not as common. This can be repaired, but I would not do so until complete healing has occurred (about 6 months) and you have been off cocaine an equal amount of time (again, to allow the healing to occur). By this time you can also tell if the hole is causing any symptoms such as breathing problems, bleeding crusting, etc. If not, you will need to do nothing.

 

Robert T. Buchanan, MD
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Septal Perforation Repair After Cocaine Use

+1

Sorry to hear about your situation. As noted below, cocaine can have significant adverse effects on the internal lining and structure of the nose. The end result is a hole, or perforation, in septum that can contribute to chronic scabbing and crusting. The hole can also disrupt the normal laminar airflow inside of the nose, thus creating more turbulence when you breathe in through the nose. Some patients with septal perforations also note intermittent whistling when they breathe in through the nose. Depending on the size of the hole, it may or may not be amenable to surgical reconstruction. Your best bet is to consult with a board certified ENT/Facial Plastic Surgeon who has experience in managing this type of complicated problem. This is not the type of problem that can be easily addressed by your average plastic surgeon with some rhinoplasty experience. It requires dedicated training in complex, challenging reconstructive nose surgery. I happen to repair this type of issue about 3-4 times per year and that is with a practice that highly emphasizes rhinoplasty and revision rhinoplasty surgery here in San Diego, CA. Good luck with your search. 

John M. Hilinski, MD
San Diego Facial Plastic Surgeon
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Septal perforations

+1

Cocaine is a pwerful vasoconstrictor and repeated use can cause septal perforations. Depending upon the size, it may or may not be able to be fixed.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 15 reviews

Options for treating septal perforation (hole in nose)

+1

What you are describing is a septal perforation.  Cocaine causes blood vessels to shrink up.  When this happens, you reduce blood flow, and tissue can die (i.e. the cartilage of your septum).  This causes the hole you describe.  The symptoms include crusting and bleeding, but can lead to long term sequelae like loss of nasal support.

The first order of business is to make sure that the patient is no longer using cocaine.  I personally use a 6 month litmus test.  The patient has to be cocaine-free for 6 months.

The ways to repair the hole are numerous.  I have experimented with many techniques and this is what works best in my hands.  I use a PDS plate and auricular cartilage to rebuild the actual hole.  after that, I rotate flaps on both sides to cover the PDS plate and the cartilage.

 

 

Raghu Athre, MD
Houston Facial Plastic Surgeon
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Septal Perforation (hole in nose)

+1

A hole in the cartilage that separates the two sides of the nose is a common complication of cocaine use, although there are multiple other causes as well.  One of the most common causes is after surgery to straighten out the septum of the nose (septoplasty).

The first step in repair of the perforation is to stop the progression of the process by getting treatment for the medical condition that caused the perforation or stopping use of cocaine.  

Once this has occurred and the perforation is stable, the perforation may be repaired.  A plastic "button" can be inserted into the perforation or, preferably, the hold can be closed surgically by taking tissue to fill in the defect.  

These cases can be challenging with a high perforation recurrence rate and so seeking care by a surgeon experienced in rhinoplasty is important.

P. Daniel Ward, MD
Salt Lake City Facial Plastic Surgeon
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These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.