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 22

Need to see an ENT surgeon ASAP

 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
4.6 out of 5 stars 24 reviews

Nasal septal perforations and saddle nose deformity

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 17 reviews

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

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 396 reviews

Repair of a saddle nose and septal perforation

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
4.8 out of 5 stars 43 reviews

Septal perforation

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 27 reviews

Treating the Hole in Your Nose

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 56 reviews

Hole in your nose is called a septal perforation

Septal perforations are holes in your septum. They can happen because of cocaine use, among many reasons. A surgeon with an ENT (Otolaryngology) background is a specialist in this problem and may be able to help you. 

-Dr. Zoumalan

Richard A. Zoumalan, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 21 reviews

Hole in the nose and nasal collapse

Dear Jayha:

          The hole in your nose is called a septal perforation, and it is not uncommon in cocaine users. If they are small and are not causing much of a problem, they can be treated symptomatically (with Ayr solution) or they can be closed with a small silastic "button" or surgery. It sounds like yours has become larger and more troublesome with some collapse of the nasal dorsum.  In this case I would encourage you to seek consultation with an experienced ENT physician, or with one of us that are double-boarded in ENT and plastic surgery. This can be improved but may take several surgeries, and the use of cartilage and rib grafts rather than any type of silicone like products for support of your nose.  Good luck, and I would seek help as soon as possible

Jerry Lugger, MD
Southlake Plastic Surgeon
5.0 out of 5 stars 3 reviews

Septal perforation and nasal collapse from cocaine use

You should have your nose examined by someone experienced with septal problems to see what's going on specifically in your nose. Cocaine use is a common etiology of such a problem. Depending on its size it may be amenable to closure.

To address the outward changes to your nose cartilage grafting typically needs to be done. Seeing a board certified facial plastic surgeon or plastic surgeon with experience in fixing noses damaged by cocaine would be the way to go.

Thomas A. Lamperti, MD
Seattle Facial Plastic Surgeon
4.9 out of 5 stars 21 reviews

Cocaine nose

Congratulations on no longer being on cocaine. It sounds like you will need nasal reconstruction wth a rib cartilage graft to support the nose. The septal perforation may be able to be repaired. Sometimes, depending on the symptoms and the configuration of the peforation it is better to remove some exposed carilage or bone to facilitate more stable healing of the mucosa. You should see an ENT physician or a double boarded ( ENT +plastic surgery) plastic surgeon or a plastic surgeon with special interest in nasal surgery.

Ernest D. Cronin, MD
Houston Plastic Surgeon
5.0 out of 5 stars 2 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.