How To Treat Hole In Nose From Cocaine Use?

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!

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.

Thank you for your inquiry and sharing what you are suffering from!

Let me start by encouraging you to try to stop PERMANENTLY using cocaine because the likelihood of success closing this perforation is very minimal if you keep using it. The reason being is the vasoconstrictive effect of cocaine that will almost always delays and causes the failure of the tissue to heal after your surgery.

As an ENT and a plastic surgeon, I highly recommend that you schedule a consultation with a well-experienced surgeon to address your septal perforation when he/she performs a good examination and explain to you the possible surgical options you have.

Please keep in mind that following the advice from a surgeon online who offers to tell you what to do without a physical examination covering the nature and the status of the tissue, assessing your desired outcome, taking a full medical history, and discussing the pros and cons of each operative solution would not be in your best interest. With that in mind, it is the safest and for your best interest to find a plastic surgeon with solid experience and certified by the American Board of Plastic Surgery who is ideally a member of the American Society of Plastic Surgeons that you will trust and be comfortable with. You should discuss your concerns with that surgeon in person.

Good luck!!!

Ali Sajjadian, MD FACS

Septal perforation is a common consequence of cocaine use.  If the perforation is symptomatic, such as recurrent bleeding or whistling, it can be surgically closed.  Closing a septal perforation requires advancing flaps of surrounding tissue to cover the opening.  Go to an ENT surgeon experienced with repairing this problem.

Septal perforations after cocaine use can be treated. Depending on the size, in general there are two options: placement of a silastic "button" that rests in the perforation. This separates the right and left side of the nose and restores some laminar flow of air into each side versus the turbulent flow you get with a perforation (it is that turbulent flow that often leads to dryness, crusting, and possible bleeding).

The other option would be through surgery. It is usually done through an open rhinoplasty type of approach with very careful separation of the right and left sided mucosa that surrounds the perforation. Then we stitch each side of the hole (the left and the right) separately and place grafting material in between. This "sandwich" is quite successful in repairing septal perforations. Of course, the larger the perforation, the more difficult it is to get closed. It also goes without saying that patients need to be off of cocaine or else the repair will fail.

I hope that helps.

Michael M. Kim, MD

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.

Web reference: http://www.seattlefacial.com/photogallery/rhinoplasty_photos24.html

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.

 

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. 

Web reference: http://www.drhilinski.com/rhinoplasty-tutorial/

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.

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.