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 36

Septal perforation due to cocaine use

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It is common for cocaine use to cause septal perforation due to the lack of blood flow in the septum. This causes the nasal mucus membranes to die and as a result holes can appear. Reconstructive surgery can be performed but there is not a guarantee that it will be successful. Before entertaining the idea of surgery you first MUST be dedicated to stay off cocaine for the rest of your life. If you were to use cocaine post surgery you could not only recreate the same problem but worsen your condition further by causing the nose to collapse. To help ensure you stay off cocaine you may want to consider a rehabilitation program and then once you feel confident that you will not use in the future consider reconstructive surgery.

Philadelphia Plastic Surgeon
4.8 out of 5 stars 25 reviews

Options in Treating Cocaine Nose Holes

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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

Hole in nose after cocaine use.

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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!

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
4.9 out of 5 stars 262 reviews

Septal perforation - no need to panic

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A hole in the septum is a treatable condition and will not cause any harm to you if left untreated. The most important question here is are you having any symptoms from the hole? Symptoms include but are not limited to nasal obstruction (caused by turbulent airflow through the nasal passage), crusting around the perforation (again from the turbulent airflow and changes is the mucous clearance in the nose), whistling (noise caused by the turbulent airflow), and bleeding. There is no need to seek treatment if you hare not bothered by one of these symptoms. If you are experiencing troubling symptoms, you have surgical and non-surgical options. The non-surgical options include placing a silicone button through the perforation. Some patients find this to be uncomfortable and annoying to care for. Surgical options vary but involve rotating tissues around to close the hole. Surgery to correct septal perforations tend to be difficult and should ALWAYS be performed by a nose expert. I hope this information was helpful - also, congratulations on your sobriety.

All the best,

Mehdi Sina, MD

Mehdi Sina, MD
New York Facial Plastic Surgeon

Septal perforation

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It appears that you have a septal perforation which is a hole in the structure that separates the right nostril from the left nostril inside the nose. The size of the perforation will determine the success of closure. This procedure can be difficult to correct, and its not always successful. You should consult with a facial plastic surgeon to access these concerns.

Dr. S

Oleh Slupchynskyj, MD, FACS
New York Facial Plastic Surgeon
4.8 out of 5 stars 281 reviews

Treating septal perforation (hole in nose)

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Hello and thanks for the question.  Based on your description, it appears you have developed a septal perforation which is a hole in the structure that separates the right nostril from the left nostril inside the nose.  The first and most important thing is to make sure you have stopped all cocaine use as this will cause more problems.  The second issue is to determine how large the hole is, as this tends to predict the likelihood of success in closure.  This will require a consultation with a rhinoplasty expert.  Keep in mind that, if the hole is not bothering you, or causing any significant crusting, bleeding or whistling, you should consider just avoiding surgery as the surgery may not be successful and has risks.  

It is also important to keep in mind that closing these holes tends to be one of the most difficult nasal surgeries.  Even experienced nasal surgeons may struggle with these surgeries.  And in some cases, the first attempt may fail.  I would recommend a consultation with a rhinoplasty expert to discuss the size of the perforation, the possible approach to closing it and also the likelihood of success. In the meantime I would recommend using nasal saline sprays several times throughout the day and coating the inside of the nose with vaseline or another water-based lubricating substance, as this will help keep the nose moist and prevent problems with dryness and crusting.  

Hope that helps and good luck!

Robert Deeb, MD
Grosse Pointe Facial Plastic Surgeon
5.0 out of 5 stars 19 reviews

Septal Perforation

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Correcting a septal perforation is one of the most difficult procedure to perform and not all perforations can be closed.  You need to be seen by a doctor to examine you and see if the hole is small enough to fix.  In the mean time you want to avoid trauma like picking and of course cocaine and things like Afrin.  Also you will want to use nasal washes to keep the mucosa moist.

Rady Rahban, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 139 reviews

Hole in Nose

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When dealing with a hole in the Septum I have found that using a Septal Button closes that hole the best. In my experience a patient can go on and have a normal life with minor daily care after this procedure.

Thank you for your question.

Gregory Roche, DO
Bloomfield Hills Facial Plastic Surgeon
4.2 out of 5 stars 19 reviews

Septal Perforation

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Septal perforations can be surgically closed but you have to make sure that you do not go back to using Cocaine. The surgery is technically challenging and not all surgeons offer it. Do your research and then proceed. In the mean time try using as much Saline Nasal Spray as possible and also use Ayr Gel in the nostrils. 


Dr Janjua

Tanveer Janjua, MD
Bedminster Facial Plastic Surgeon
5.0 out of 5 stars 122 reviews

A hole in the septum (septal perforation) from cocaine use is difficult to repair

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A septal perforation is a difficult and sometimes impossible problem to correct. You need to see an experienced surgeon who has specific experience treating this problem.

Eric Swanson, MD
Kansas City Plastic Surgeon
4.7 out of 5 stars 61 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.