What to do about the hole in my nose?

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.

Thank you for your question.
Septal perforations do not always enlarge, but some do. If it is enlarging you need to see a board certified ENT/FPRS to examine the nose. A biopsy may be indicated. Septal perforation can be repaired after 1 year off cocaine. Also at the same time any external nasal shape deformity can be corrected. I hope this helps

You should really go see an ENT specialist (ear-nose-throat) as soon as possible to give you a detailed exam and see what can be done to help you foremost with your functional problems, as well as the aesthetics of it. There should be an ENT specialist available in any ER for diagnostics.
It is unwise to self medicate in this case, even if it is just nasal spray, since it has been going on for years now and it is not getting any better. Also, putting anything in your nose at this stage, without the advice of a medical expert, can do more harm. 

You should definitely see a specialist, ASAP!! The hole in your septum is due to the damage caused by the cocaine. This will require a proper reconstruction of the cartilage and mucosa of the nasal septum that if not managed properly can cause further collapse of your nose and breathing problems.
Hope this helps,
Ali Rıza Öreroğlu, MD FEBOPRASEuropean and Turkish Board Certified Aesthetic, Plastic and Reconstructive SurgeonIstanbul, Turkey

Depending on the size, it can be repaired. However it is a difficult procedure so find a surgeon with experience in this area. If the nose is caving in, it can be fixed at the same time. It all starts with the consultation.

Cocaine use is commonly associated with nasal septal perforations, or a "hole" to the septum.  This can sometimes be repaired surgically but can be a challenging issue.  I recommend you visit with a plastic surgeon who is skilled with complex nasal surgeries and reconstructions to discuss your options.

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. RegardsDr. Janjua

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!

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

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