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!
How To Treat Hole In Nose From Cocaine Use?
Doctor Answers 24
Septal perforation due to cocaine use
Hole in nose after 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!
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.
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Treatment for hole in nose due to cocaine use
It’s ironic in answering this question that it touches on the history of Rhinoplasty. Cocaine placed in the nose is absorbed into the mucosa and causes two things: constriction of the blood vessels (decreasing bleeding) and numbing. These two properties are ideal for performing rhinoplasty under what is commonly called “local” anesthesia, and was the standard for decades when general anesthesia was very risky. Times have changed and Rhinoplasty is most commonly performed under general anesthesia supplemented with Lidocaine, since Cocaine can also cause an irregular heart beat as well as unsafe elevation of blood pressure.
Repeated recreational use of Cocaine causes repeated constriction of the tiny blood vessels that supply the lining of the nose (i.e. the mucosa). In essence, it is like putting a tourniquet on the inside of the nose. Over time, this lack of blood supply thins the lining of the nose to the point where it eventually dies. The underlying cartilage of the septum relies on its blood supply from the overlying mucosa, and so when it loses its blood it dies as well resulting in a hole in the septum. Small holes in the septum will create a whistle nose with breathing; large holes will develop crusting on the perimeter of the hole along with occasional bleeding. In extreme cases of perforation, the bridge of the nose can even collapse.
A septal perforation can be surgically closed, but it is important to know that there is no guarantee this will occur even in the hands of the best of surgeons. In general, the smaller the perforation, the better the odds are of complete closure. However, a perforation caused from previous surgery or trauma still has a normal blood supply surrounding it, and therefore will have a success rate of closure; a perforation from Cocaine use has a compromised surrounding blood supply that will never return to normal. That being said, by a surgeon skilled in this procedure, you still have a relative chance for success and you should at least give the surgery a chance to see if it can be closed.
The procedure can be done in a “closed” approach in which all incisions are inside the nose. However, this approach is creates a limited view and access for this technically challenging surgery, and is especially true for large perforations, or ones that are farther back in the nose. The more common approach is “open” which is the identical approach for an “open rhinoplasty.” In this approach, one small incision is placed along the base of the nose (the columella”) and all other incisions are internal. This one small incision allows the surgeon to elevate the skin of the underlying structures of the nose, giving excellent visualization and access to obtain the optimal result for the patient.
The procedure consists of elevating the mucosa on each side of the septum and covering the hole with these two pieces of elevated tissue referred to as “mucosal flaps.” It is now fairly common to place a layer of human tissue such as Alloderm in the hole prior to rotating the flaps over the hole, in order to provide additional support for the flaps to attach to. What is crucial for success is for these flaps to live during the first 4-6 weeks as they heal over the perforation. Studies have shown that one of the key elements for this to occur is moisture in order to keep the flaps alive. To that end, it is common for the surgeon to place a thin layer of soft clear plastic sheeting in each nostril against the flaps to help trap the nose’s natural mucous which is Mother Nature’s version of moisture. These thin sheets are removed typically at six weeks after surgery at which time the septum can finally be re-assessed.
Hope you found my answer helpful. All the best!
Septal perforations may be closed if they are small and located near the bottom of your septum.
Wishing you well.
Septal Perforation after cocaine use
An in-person exam with a board-certified plastic surgeon is the best way to assess your needs and provide true medical advice. The response to the question does not constitute a doctor patient relationship or formal advice.
Repair of a perforation (hole) in the septum
Septal Perforation Repair
Hole in Nose
Reconstruction of the 'cocaine nose'
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.