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 20

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
5.0 out of 5 stars 17 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
5.0 out of 5 stars 220 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
5.0 out of 5 stars 94 reviews

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!

Anand D. Patel, MD
Brookfield Facial Plastic Surgeon
5.0 out of 5 stars 13 reviews

Hole in Nose

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.

Johnny Mao, MD, FACS
Orange Facial Plastic Surgeon
5.0 out of 5 stars 17 reviews

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.

Bryan Correa, MD
Houston Plastic Surgeon
5.0 out of 5 stars 9 reviews

Closing a septal perforation

Congratulations on stopping cocaine use.  Continuing to abstain from cocaine is the single best thing you can do for you nasal health and your general health overall.

Once a hole has formed in the septum (the wall between the right and left nasal passages), it rarely if ever closes on its own.  There are many different options to close the hole including non-surgical and surgical management.

The single best advice is to go to surgeon who is well versed in closure. It clear from your post that you want this corrected as soon as possible, but you should ask around, do your research, and do not rush into the operating room.  You should absolutely make sure you are free from cocaine use before any surgery is done.

Good luck from Manhattan.

Benjamin C. Paul, MD
New York Facial Plastic Surgeon
5.0 out of 5 stars 21 reviews

Rebuilding a nose after cocaine use

You should be advised that this hole will continue to worsen and enlarge should you continue to use cocaine. I would suggest that you seek out a plastic surgeon who has experience rebuilding tissue as this procedure is not typically a rhinoplasty treatment. If you do not close this hole and repair the nose it can eventually collapse.
Treatment is essential. 

Septal perforation from cocaine use

Cocaine use is a well known cause of septal perforation.  This happens because cocaine causes blood vessel constriction, particularly in the area where it contacts.  Blood vessel constriction results in reduced blood flow to the tissues, sometimes to the point where the tissues do not get enough to survive.  This leads to tissue necrosis.  The septum (wall between one side of the nose and the other) is particularly susceptible to this.  When perforations are small, they may cause no problems at all, or can lead to turbulent air flow through the nose and lead to the sensation of nasal congestion, crusting/scabbing/bleeding, and occasionally whistling when you breath.  When the holes are larger, they can lead to loss of support to the nose and what is known as a "saddle nose deformity" where the mid and/or lower portion of the nose collapses.  This is a very unfortunate and avoidable cosmetic deformity that regrettably I have treated many times.  The most important thing is to stop cocaine usage all together as well as other nasal vasoconstrictors (afrin/oxymetaziline/neosynephrine, etc) as the problem can always get worse.  Management depends on the resulting symptoms.  If you do not notice a change to the shape of your nose, change to your breathing, are not getting nose bleeds or crusting and no whistling, then there isn't anything that needs to be done.  On the other hand, if you are having one or more of those symptoms, then the perforation can be repaired.  The type of repair depends on the size and location of the perforation.  There are also non-surgical options.  Consult with a rhinoplasty expert who has extensive reconstructive experience with septal perforation as these cases can be very challenging for surgeons who only perform straight forward cosmetic rhinoplasty.

Sirius K. Yoo, MD
San Diego Facial Plastic Surgeon
5.0 out of 5 stars 21 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.