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RECONSTRUCTIVE SURGERY

No reconstructive surgery will be successful if the patient does not stop using cocaine. The first all-important step is to stop using cocaine. In many ways, the nasal injury caused by cocaine is similar to the process of nasal vasculitis. It is important to note that cocaine can cause an inflammatory process in the nose that can persist even after the patient has stopped snorting cocaine. Symptoms include mucosal bleeding, shortness of breath, crusting in the nose and sometimes nasal pain. These are all signs of active cocaine use. As cocaine use continues, the cycle of inflammation and healing continues. The cartilage in the septum will also weaken due to the inflammation. This can lead to a septal perforation (hole in the septum).

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NOSE DAMAGE CAUSED BY COCAINE USE

As the perforation increases, further weakening occurs in the middle part of the nose and can lead to a saddle nose deformity. As the septum becomes more and more damaged, the saddle deformity can worsen. The nose shortens and the tip of the nose turns upwards. With a further cycle of inflammation and healing, the damage to the nose extends to the inner lining of the nose. This shrinks due to scarring and further shortening of the nose occurs. With continued use, the columella (the strip of skin between the nostrils) of the nose may slowly disappear. The end result is a shortened nose with defects in the inner layer of the nose and the cartilage framework, or a total nasal prolapse.

Total collapse of the nose due to vasculitis 

Long-term use of cocaine can wear away the hard palate, causing a fistula from the mouth to the nose. When this happens, fluid can leak from the mouth into the nose when drinking. Once the patient has stopped using cocaine, these deformities of the inner lining, nasal cartilage framework, and skin covering can be repaired. The type of reconstruction needed will depend on the severity of the saddle nose deformity, ranging between simple reconstruction, intermediate reconstruction, and complex reconstruction (partial nasal amputation or partial rhinectomy).

EXECUTIVE DOCTOR

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CALLUM FARIS

ENT specialist and specialist in facial plastic surgery

Frequently Asked Questions About Cocaine Nose Injury

What is "cocaine nose," and how does cocaine use damage the nose?

“Cocaine nose” is a term used to describe the structural and functional damage to the nose resulting from repeated intranasal cocaine use. Cocaine acts as a potent vasoconstrictor, which means it narrows the blood vessels in the nasal tissues. Over time, reduced blood flow leads to tissue death (necrosis), resulting in the breakdown of cartilage, septal perforations (holes in the nasal septum), and even collapse of the nasal bridge.

What are the common symptoms and signs of nasal damage caused by cocaine use?

Common signs and symptoms include nasal congestion, frequent nosebleeds, crusting, pain or discomfort in the nose, and difficulty breathing through the nose. As the damage progresses, individuals may notice a whistling sound when breathing (a sign of a septal perforation), visible deformity of the nose, and loss of structural support leading to nasal collapse.

Can my nose be reconstructed after damage from cocaine use, and what are the treatment options?

Nasal reconstruction is possible after cocaine-induced damage, but the treatment plan depends on the extent of the injury. Treatment typically includes septal repair, cartilage grafting (often from the ear or rib), and external rhinoplasty techniques to rebuild the nose.

How long do I need to stop using cocaine before I can undergo reconstructive surgery?

Most surgeons require patients to be completely drug-free for at least 6 to 12 months before considering reconstructive surgery. This period allows for stabilization of the nasal tissues and ensures better healing outcomes.

What types of reconstructive procedures are available for cocaine-related nasal injuries?

Depending on the severity of damage, reconstructive procedures can include setpal reconstruction, septal perforation repair, complex nose reconstruction. It often requires the use of nasal flaps, skin flaps, cartilage grafting from the ear, rib, or septum, and external rhinoplasty to rebuild the nasal framework.

What is the recovery process like after cocaine nose reconstruction surgery?

Recovery varies by the complexity of the surgery; initial swelling and bruising typically subside within 2–3 weeks, but full healing and final results can take several months. Long-term success depends on proper healing and strict abstinence from cocaine or other nasal irritants.

Are multiple surgeries often required to fully repair cocaine-induced nasal deformities?

Due to the extent of tissue loss, scarring, and poor vascular supply in damaged noses, multiple surgeries are required in approximately 25% of the case that we see. The first surgery may focus on stabilizing the nasal structure and restoring function, with follow-up procedures refining cosmetic appearance or addressing lingering functional issues.

What are the risks and potential complications associated with cocaine nose reconstruction surgery?

Risks include infection, bleeding, poor wound healing, graft failure, persistent breathing problems, and unsatisfactory aesthetic results. Patients must also maintain sobriety, as relapse into cocaine use can undo surgical repairs.

How do I know if I am a suitable candidate for reconstructive surgery after cocaine-related nasal damage?

This surgery is highly specialized and not a routine rhinoplasty. rnrnPlease seek an opinion from a qualified facial plastic and reconstructive surgeon with an interest in reconstructive rhinoplasty/nose reconstruction and ideally large experience in cocaine nose reconstruction to assess your overall health, extent of nasal damage, and your commitment to sobriety. rnrnCandidates must have been drug-free for a significant period, show signs of stable physical and mental health, and have realistic expectations about the results.

Will reconstructive surgery restore both the function and appearance of my nose after cocaine damage?

While complete restoration may not always be possible in severe cases, reconstructive surgery can significantly improve both the function and appearance of the nose. Outcomes vary, but with proper planning, surgery can offer very meaningful improvements in breathing, self-confidence, and quality of life.

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