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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 12

Options in Treating Cocaine Nose Holes

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.

Memphis Plastic Surgeon
5.0 out of 5 stars 73 reviews

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Cocaine use - septal perforation

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

Ali Sajjadian, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 166 reviews

Septal perforation

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.

Ronald J. Edelson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 14 reviews

Septal Perforation after cocaine use

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

Michael M. Kim, MD
Portland Facial Plastic Surgeon
5.0 out of 5 stars 27 reviews

Treatment for hole in nose due to cocaine

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
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 62 reviews

Nasal Septal Perforation after Cocaine Use

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
Highlands Plastic Surgeon
5.0 out of 5 stars 4 reviews

Septal Perforation Repair After Cocaine Use

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
4.5 out of 5 stars 23 reviews

Septal perforations

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 18 reviews

Options for treating septal perforation (hole in nose)

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
4.5 out of 5 stars 48 reviews

Septal Perforation (hole in nose)

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
5.0 out of 5 stars 13 reviews

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.