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 29

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.

Philadelphia Plastic Surgeon
4.8 out of 5 stars 21 reviews

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.

Peter A. Aldea, MD
Memphis Plastic Surgeon
4.9 out of 5 stars 108 reviews

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!

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
4.9 out of 5 stars 255 reviews

Septal perforation repair

Hello and thanks for your answer. First, as others have suggested, I would suggest you seek help to make sure you are off the cocaine. Once free of this substance, a septal perforation repair can be done, often with a rhinoplasty to adjust the structural changes associated with effects of cocaine. If it crusting, causing obstruction, bleeding, or whistling then you are definitely a candidate. If the holes are larger than 3 cm however certain extreme measures such as transposition flap, free flaps, or intranasal tissue expanders can be entertained. A consultation with a rhinoplasty expert will help in your decision making. 

Giancarlo Zuliani, MD
Rochester Facial Plastic Surgeon
5.0 out of 5 stars 61 reviews

Cocaine septal perforation

Cocaine causes small blood vessels in the lining of the nose to constrict and go into spasm. This can lead to the death of the mucosa and, eventually, the underlying cartilage. This may lead to a hole in the septum causing a communication between the two nostrils.

A hole in the nasal septum (septal perforation) following cocaine use is hard to treat. Firstly, patients must undertake to cease cocaine and cigarettes permanently (which is a difficult undertaking for the addicted patient).

Cocaine related nasal septal perforations commonly present with crusting, "whistling" during breathing and bleeding. If the hole gets large enough, the whistling disappears. If enough of the septum is destroyed by cocaine, the nose will collapse and there is no cartilage left to support the lower two thirds of the nose.

Reconstructive surgery for a cocaine nose is difficult. Small holes can be "plugged", either with synthetic materials of with local tissues which have been moved around ("local flaps"). If the nose has collapsed, then a rhinoplasty usually involving cartilage harvested from the rib cage is performed to rebuild the nose. This is a significant surgical undertaking.

Damian Marucci, MBBS, PhD, FRACS
Sydney Plastic Surgeon
5.0 out of 5 stars 11 reviews

Septal perforation

Septal perforation can occur after cocaine use.  The membranes lining the septum, as well as the cartilage in between, can be damaged and die, leaving a hole between the left and right sides of the nose.  Septal perforations become problematic if the support of the nose (especially bridge and tip) is compromised, if there is bleeding, infections, significant crusting, pain or if the hole is progressively enlarging.  In these cases, surgery can be performed in many cases to repair the hole.  In other cases, conservative care can limit symptoms and surgery might not be necessary.  Seek care from a qualified facial plastic or plastic surgeon who performs this kind of surgery.

Anthony P. Sclafani, MD
New York Facial Plastic Surgeon

Cocaine Nose Repair

Often, if it is too large and not symptomatic, I would consider not repairing the septal perforation or hole in the septum as the failure rate is often quite high.  Consult your Board Certified rhinoplasty expert to see what options will work for you.

Rod J. Rohrich, MD
Dallas Plastic Surgeon
4.9 out of 5 stars 61 reviews

Perforated Septum from Cocaine Abuse

If you've burned a hole in your septum from snorting cocaine or heroin, or had an overly aggressive septoplasty or sinus procedure, help is most certainly available. Seek out a board certified plastic surgeon or otolaryngologist to consult with in your area who treats individuals with septal perforations. 

Randolph Capone, MD, FACS
Baltimore Facial Plastic Surgeon
4.7 out of 5 stars 51 reviews

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!

Burke Robinson, MD, FACS
Atlanta Facial Plastic Surgeon
4.7 out of 5 stars 51 reviews

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.
Dr Joseph

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon
4.9 out of 5 stars 418 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.