Septal perforation due to cocaine use
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.
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.
Septal perforations may be closed if they are small and located near the bottom of your septum.
The most important factor is complete elimination of sniffing cocaine. Cocaine sniffing may lead to midline nasal destructive disorder, and nasal septal perforations from cocaine use may be difficult or impossible to repair. Perforations greater than 10 mm in diameter that do not whistle with breathing may be the most likely have a poor surgical result.
Wishing you well.
Septal Perforation after cocaine use
The treatment depends on the size of the perforation of your nasal septum. If it is a small hole, it can make a whistling noise while breathing, which would need reconstructive surgery borrow nasal mucosa from the opposing wall. A septal perforation without symptoms may be better to not have any surgery as the surgeries are complex and do not always correct the problem. The worst compilation is collapse the dorsum if the majority of the septum is destroyed. A full evaluation can tell you what treatment option is best. Best of luck, Dr. Michael
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
Thanks for the question. Septal perforations can be very symptomatic, with many patients experiencing bleeding, crusting, whistling, and trouble breathing. To repair them, I use a cutting edge technique that involves a dissolvable PDS plate and temporalis fascia. The PDS plate takes around 3 months to dissolve and in the meantime, helps to stabilize the repair. The temporalis fascia is the covering of the bite muscle in the temple, removed with a tiny (~1/2 inch) incision above the ear in the scalp. With this technique I've successfully closed many perforations deemed too large to be closed, with a very high success rate. The repair can be performed with an endonasal (no external incisions) or open (with a tiny incision between the nostrils) approach. The approach depends on perforation size, location, and whether any additional procedures are necessary (rhinoplasty, valve repair, septoplasty, etc.). If you are experiencing symptoms from your septal perforation, seek a consultation with a surgeon who specializes in this delicate and technically challenging procedure.
Septal Perforation Repair
If you are not having symptoms of nasal obstruction, crusting, bleeding, pain, or whistling then you may not need a repair. However, the perforation may enlarge in time, and if large enough, may not then be repairable. You must dedicate yourself to never using any intranasal drugs ever again, or it will most certainly worsen. We perform a septal perforation repair though an incision between the nostrils and incisions inside the nose. The recovery is about 7-10 days. I wish you the best of luck!
If the hole in nose (septum) is not too big, less than 2 cm in diameter and in good position (central part of the cartilage portion of the septum), it can usually be closed but requires an open rhinoplasty approach to elevate septal flaps in the nose and advance the flaps towards each other on either side and suture approximate the flaps. It may also require a fascia graft (thin layer) usually harvested from the temporal region of the scalp and used as an "interpositional" graft to act as a scaffold for the cells to migrate and heal. I know this is a lot of surgical detail and indeed it is a potentially tedious but rewarding procedure to perform.
Reconstruction of the 'cocaine nose'
Reconstruction of the 'cocaine nose' is not easy but can be done. In essence this requires the use of tissue inside the nose to provide coverage of the defect or hole in the septum.
Septal perforation due to cocaine use
Unfortunately cocaine can commonly cause this problem - called a 'septal perforation.' These can be difficult to treat depending on the size, but there are treatment techniques available. I would recommend strict, permanent cocaine cessation, and a formal consultation so an exam can be performed.
I hope this helps.