I have a perforated septum due to cocaine abuse in the 90s. Can it be repaired? (Photo)

Nasal inhalation of cocaine causes the blood vessels to constrict, tissue to die, chronic wounds to develop - creating large septal perforations and a gradual "chemical burn" injury to the internal nasal lining of the nose.  The septum provides the nose support and when enough of this dies or necrosis - the nose collapses into a "saddle nose" deformity.  Much of the deformity seen in the cocaine saddle nose is actually due to a severely scarred and contracted lining.  The normal mucosal nasal lining becomes so scarred and contracted from chronic cocaine use that it shrinks down, becomes stiff and rigid and cannot expand or accomodate cartilage grafts.  One of the major difficulties with the cocaine nose is that there is just not enough internal lining to allow expansion of the external nasal structures with structural cartilage grafting alone.  Patents have to absolutley have quit cocaine and smoking.  Both will cause absolute reconstructive failure and potentially result in complete nasal loss. For less severe cases, Open rhinoplasty technique with a patient's own rib cartilage grafting may be enough to reconstruct a normal nose.  I personally never use cadaver rib as I feel it has too high of an infection and extrusion rate. For the most severe cocaine nose deformity reconstruction, I perform a 3 stage forehead flap with rib grafting (from the patient - NOT A CADAVER.). This is a minimum of 3 stages and frequently improves with further smaller procedures.This is a technically challenging endeavor.  It is absolutley imperative that patients seek a consultation with an ABPS board certified plastic surgeon, less they chance further excessive risk for further compication and deformity.

As a dual board certified facial plastic surgeon I specialize in complex reconstruction of nasal deformities. I would suggest that you research a facial plastic surgeon who is fellowship trained to address this complex problem in your area .

Good Luck
Robert F. Gray, MD, FACS

Yes it can be repaired but only by an expert who does this type of reconstruction frequently. Try Dean Toriumi in Chicago. good luck.