What to do about the hole in my nose?

Not really sure if this is the right place but I have a hole in my nose from doing cocaine about 5 years ago. This hole is growing in size even though I've stopped the drugs for over 3years now. My nose is falling apart and its really depressing me. What can I do to fix it, I know the cartilage wont grow back so for the last 1.5 yrs I've been putting Ayr nasal gel and petroleum jelly on the exposed cartilage. Now the whole nose is caving in on me and there is a hole the size of my index finger that can almost fit through from one side to another. PLEASE HELP in any way possible.

Doctor Answers 25

Need to see an ENT surgeon ASAP

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 You should see an ENT surgeon ASAP for proper evaluation and instructions on performing nasal washes to prevent a chronic nasal infection.  It's unwise to place any oil based product inside the nose as this can cause lipoid pneumonia if it gets into the lungs.  Ayr is water based and would not be in this category, but petroleum jelly is oil-based.

Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 28 reviews

Nasal septal perforations and saddle nose deformity

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Yes, this can be a debilitating condition both for breathing and appearance. If the perforation is not too large, it may be repaired surgically. Also, the bridge may be reconstructed with your own or donor rib cartilage. To help prevent further enlargement, it is imperative you practice proper nasal hygeine and would recommend seeing a specialist right away.

Anand D. Patel, MD
Brookfield Facial Plastic Surgeon
5.0 out of 5 stars 22 reviews

Septal Perforation closure may not be necessary

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Few surgeons actually have a lot of experience with septal perforations (hole in your septum) and as a result finding someone who can help can be difficult.

Luckily, we have a lot of expereince with this procedure and can help you determine whether attempting closure is possible or worth pursuing. In those case when the hole is very big and closure cannot be accomplished, patients can often have problems with the bridge of the nose or even the tip collapsing. In those cases, we can speak to you about how we can build up the necessary support so that your nose can be stable and function long term.

Warm Regards,

Peyman Solieman, MD

Peyman Solieman, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 3 reviews

Nasal septal perforation

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A hole in the septum can be repaired along with reconstruction of the nasal dorsum to address the sinking nose. The procedure will fail in cases of ongoing cocaine use. It is important to maintain good nasal hygiene before and after surgery. 


Dr. Janjua

Tanveer Janjua, MD
Bedminster Facial Plastic Surgeon
5.0 out of 5 stars 126 reviews

How to treat a hole in the nose after cocaine use

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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
4.4 out of 5 stars 56 reviews

What to do about the hole in my nose?

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This is a very complex and significant problem.  It is important to be seen sooner rather than later for proper evaluation and then a discussion about treatment options.  This may not be able to be corrected in one surgery.  Continue to use the water based products and work to eliminated to oil based products inside your nose.

Collapse of your nose may require evaluation and possibly a biopsy.

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Cocaine use may lead to a condition called midline nasal destructive disorder which may lead to loss of structural support and visible collapse. Other conditions like Wegener's Granulomatosis, sarcoidosis, and autoimmune disease may need to be ruled out with a nasal biopsy, depending on your specific condition and examination. Consider consulting with a reputable ENT or facial plastic surgeon.Wishing you well.Dr Joseph

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon
4.9 out of 5 stars 435 reviews

Repair of a saddle nose and septal perforation

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Thanks for the question and congratulations on ceasing your cocaine habit. The external structure of your nose can likely be rebuilt using rib cartilage. The perforation may be closed at the same time, depending on the size and location. I use a PDS plate and temporalis fascia, the covering of the bite muscle in the temple. This technique has made it possible to close perforations which were previously thought to be too big to close. I'd recommend you seek consultations with surgeons who specialize in rhinoplasty and are board certified in facial plastic surgery or plastic surgery. Ask specifically if they specialize in perforation repairs and how many they do per year. 

Best regards,
Dr. Mehta

Umang Mehta, MD
Bay Area Facial Plastic Surgeon
4.7 out of 5 stars 52 reviews

Septal perforation

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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 28 reviews

Treating the Hole in Your Nose

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It sounds as though you have a septal perforation, a very common symptom of cocaine usage. Typically, the hole caused by a septal perforation can be aided by cleansing the nose with a saline solution or with a gel, as you described. However, if the structure of your nose starts to cave, these at-home solutions are no longer effective. If left untreated, your septal perforation can cause discomfort in the form of pain or difficulty breathing. It is important that you seek professional help ASAP, as the septal perforation can grow bigger over time. 

Sam Rizk, MD
New York Facial Plastic Surgeon
4.7 out of 5 stars 79 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.