Ask a doctor

What to do about the hole in my nose?

Not really sure if this is the right place but I have a hole in my nose from doing cocaine about 5 years ago. This hole is growing in size even though I've stopped the drugs for over 3years now. My nose is falling apart and its really depressing me. What can I do to fix it, I know the cartilage wont grow back so for the last 1.5 yrs I've been putting Ayr nasal gel and petroleum jelly on the exposed cartilage. Now the whole nose is caving in on me and there is a hole the size of my index finger that can almost fit through from one side to another. PLEASE HELP in any way possible.

Doctor Answers 19

Need to see an ENT surgeon ASAP

 You should see an ENT surgeon ASAP for proper evaluation and instructions on performing nasal washes to prevent a chronic nasal infection.  It's unwise to place any oil based product inside the nose as this can cause lipoid pneumonia if it gets into the lungs.  Ayr is water based and would not be in this category, but petroleum jelly is oil-based.


Beverly Hills Facial Plastic Surgeon
4.5 out of 5 stars 12 reviews

Cocaine Nose

An early cocaine nose has exactly what you described: a septal perforation. A late cocaine nose has complete collapse or a saddle nose deformity.

I am very sorry you experienced this.  There is a way to correct this, but it is an involved surgery that requires a rib cartilage graft.

You should find a plastic surgeon who has experience treating this, once you promise to yourself and the world that you will never snort cocaine again (or use it in any way). It also requires a septal flap with mucosa and cartilage to fill the hole in some cases.

Septal perforation

Cocaine use is a well known cause of septal perforation. This happens because cocaine causes blood vessel constriction, particularly in the area where it contacts. Blood vessel constriction results in reduced blood flow to the tissues, sometimes to the point where the tissues do not get enough to survive. This leads to tissue necrosis. The septum (wall between one side of the nose and the other) is particularly susceptible to this. When perforations are small, they may cause no problems at all, or can lead to turbulent air flow through the nose and lead to the sensation of nasal congestion, crusting/scabbing/bleeding, and occasionally whistling when you breath. When the holes are larger, they can lead to loss of support to the nose and what is known as a "saddle nose deformity" where the mid and/or lower portion of the nose collapses. This is a very unfortunate and avoidable cosmetic deformity that regrettably I have treated many times. The most important thing is to stop cocaine usage all together as well as other nasal vasoconstrictors (afrin/oxymetaziline/neosynephrine, etc) as the problem can always get worse. Management depends on the resulting symptoms. If you do not notice a change to the shape of your nose, change to your breathing, are not getting nose bleeds or crusting and no whistling, then there isn't anything that needs to be done. On the other hand, if you are having one or more of those symptoms, then the perforation can be repaired. The type of repair depends on the size and location of the perforation. There are also non-surgical options. Consult with a rhinoplasty expert who has extensive reconstructive experience with septal perforation as these cases can be very challenging for surgeons who only perform straight forward cosmetic rhinoplasty.

Sirius K. Yoo, MD
San Diego Facial Plastic Surgeon
5.0 out of 5 stars 9 reviews

Treating the Hole in Your Nose

It sounds as though you have a septal perforation, a very common symptom of cocaine usage. Typically, the hole caused by a septal perforation can be aided by cleansing the nose with a saline solution or with a gel, as you described. However, if the structure of your nose starts to cave, these at-home solutions are no longer effective. If left untreated, your septal perforation can cause discomfort in the form of pain or difficulty breathing. It is important that you seek professional help ASAP, as the septal perforation can grow bigger over time. 

Sam Rizk, MD
New York Facial Plastic Surgeon
4.5 out of 5 stars 26 reviews

Hole in your nose is called a septal perforation

Septal perforations are holes in your septum. They can happen because of cocaine use, among many reasons. A surgeon with an ENT (Otolaryngology) background is a specialist in this problem and may be able to help you. 

-Dr. Zoumalan

Richard A. Zoumalan, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 14 reviews

Hole in the nose and nasal collapse

Dear Jayha:

          The hole in your nose is called a septal perforation, and it is not uncommon in cocaine users. If they are small and are not causing much of a problem, they can be treated symptomatically (with Ayr solution) or they can be closed with a small silastic "button" or surgery. It sounds like yours has become larger and more troublesome with some collapse of the nasal dorsum.  In this case I would encourage you to seek consultation with an experienced ENT physician, or with one of us that are double-boarded in ENT and plastic surgery. This can be improved but may take several surgeries, and the use of cartilage and rib grafts rather than any type of silicone like products for support of your nose.  Good luck, and I would seek help as soon as possible

Jerry Lugger, MD
Southlake Plastic Surgeon
5.0 out of 5 stars 3 reviews

Septal perforation and nasal collapse from cocaine use

You should have your nose examined by someone experienced with septal problems to see what's going on specifically in your nose. Cocaine use is a common etiology of such a problem. Depending on its size it may be amenable to closure.

To address the outward changes to your nose cartilage grafting typically needs to be done. Seeing a board certified facial plastic surgeon or plastic surgeon with experience in fixing noses damaged by cocaine would be the way to go.

Thomas A. Lamperti, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 15 reviews

Cocaine nose

Congratulations on no longer being on cocaine. It sounds like you will need nasal reconstruction wth a rib cartilage graft to support the nose. The septal perforation may be able to be repaired. Sometimes, depending on the symptoms and the configuration of the peforation it is better to remove some exposed carilage or bone to facilitate more stable healing of the mucosa. You should see an ENT physician or a double boarded ( ENT +plastic surgery) plastic surgeon or a plastic surgeon with special interest in nasal surgery.

Ernest D. Cronin, MD
Houston Plastic Surgeon
5.0 out of 5 stars 2 reviews

Hole in the nose

A hole between the common wall of your nose is called a septal perforation. The size dictates treatment. when small (<0.5cm) surgical success is high and should be considered. When large (>2cm) the successful closure is poor and surgery isn't recommended. Medical treatment in the form of nasal washes and daily lubrication is better for most people. However for the collapse of the bridge of your nose surgery is helpful. Its a lot of reconstructive surgery and requires cartilage harvested from either your ear or rib. 

Oakley Smith, MD
Toronto Facial Plastic Surgeon
5.0 out of 5 stars 38 reviews

Septal perforation and nasal collapse

Dear Jayha - thanks for your question - you have a very difficult problem but one that is reparable based on your description.  The septal perforation repair operation and the reconstructive effort for the falling nose second to the perforation is the most difficult operation that we as Facial Plastic Surgeons do - finding a doctor with a good number of these operations under his or her belt is important.  I would make no consideration for enlarging the perforation as this is counter productive and I would also suggest that the reconstructive effort entail the use of no plastic, silicone or gortex materials.  Your nose is currently living in a state of chronic low grade infection - the likely hood of these previously mentioned grafts getting infected is certainly higher than if cartilage grafts (rib) are used preferentially.  The art of perforation repair is slowly dying so do your homework and choose one of us who performs this operation frequently - good luck.

 

PK (peconic-faces.com) 

Paul E. Kelly, MD
Hamptons Facial Plastic Surgeon
4.5 out of 5 stars 2 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.