Cocaine Nose

Addictions plague many people, and recovery is not always easy, even for those lucky enough to beat their addiction. Permanent issues may persist depending on the addiction, or even if no addiction is present and the user is a casual one. Cocaine use and addiction may lead to a condition known as “cocaine nose.”

What is Cocaine Nose?

Cocaine causes constriction or closing of blood vessels. When cocaine is snorted through the nose, it causes the blood vessels in the nasal lining to constrict. Chronic cocaine usage can result in prolonged constriction of the nasal lining blood vessels with the resultant death of these tissues. This results in sores in the nasal lining and septum that can lead to perforations of the septum, infection, loss of supporting cartilage, scarring, and eventual collapse of the nose. The resultant constellation of deformities is commonly known as “cocaine nose”. Unique to the cocaine nose is the relative sparing of the external skin cover, but underneath lie many, many problems.

Why have a Cocaine Nose Procedure?

The injuries sustained from long-term cocaine use are uncomfortable and painful at first but may heal over time. Repeated cocaine injury can lead to life-threatening conditions such as infection. Since infections can occur at the site of injury (in this case the nose), bacteria can make their way into the adjacent sinuses, or even the brain cavity causing an even more dangerous infection. Cocaine users can lose their sense of smell, and since cocaine use destroys the lining of the nose, the normal production and propagation of mucous blood to the back of the throat where it can be swallowed is impaired. The mucous, sitting idle in the nasal cavity, becomes dried and forms large impactions in the nasal cavity and pharynx that can obstruct the nasal airflow, cause bad breath, and harbor infection.

The nasal deformities resulting from cocaine use do not correct on their own. In fact, cocaine injury to the nasal tissues results in tissue healing in and around the nose being impaired for the life of the patient. Cocaine injured tissues have poor circulation, are frequently scarred, and surgical manipulation of cocaine-injured tissues carries a high risk for infection and delayed healing. Early injuries causing sores inside the nose can heal between episodes of cocaine abuse. If frequent cocaine abuse prevents healing, the sores can lead to a local infection that causes destruction of the supporting cartilage and bone in the nose resulting in collapse. The chronic infection/ inflammation of the nasal lining causes it to shrink and become replaced by scar tissue furthering distorting the external appearance of the nose. The results of cocaine injury to the nose vary widely and may present as an early perforation of the nasal septum to the full-blown collapse of the nose with destruction of normal nasal shape and anatomy. Early medical or surgical intervention of cocaine nose may help stifle the progression of the deformity. Treatment of advanced nasal deformities resulting from cocaine abuse is often complex and may require a staged surgical approach over several months.

During and after the Cocaine Nose Procedure

Surgery for the deformities that constitute cocaine nose is as widely varied as the deformities themselves. Minor deformities can often be managed with a simple outpatient rhinoplasty procedure. Large perforations of the nasal septum, the collapse of the nose, and loss of nasal lining will require more technically detailed and demanding approaches. During your consultation with Dr. Walton, the most appropriate and safe treatment approach will be outlined and reviewed.

For the most severe deformities, restoration of the nasal lining may be the best approach to improve nasal structure and function. Dr. Walton has devised a technique for restoration of the nasal lining using tissue from the forearm configured to the exact dimensions and shape of the normal nasal lining. Once configured on the forearm, the nasal lining (called the “bat flap” because of its unique shape) is transferred to the inside of the nose to replace the diseased nasal lining using microsurgical techniques. The healthy lining tissue improves the blood circulation to the cocaine-injured nose and provides a lasting solution for the correction of the cocaine nose deformity. Following the insertion of the new lining flap, cartilage grafts are placed to support the tissues and restore shape to the nose.

Patients can expect to stay in the hospital for 3 to 4 days or longer after the initial microsurgical procedure. Usually, patients will require monitoring the circulation of the new lining flap in a special hospital unit for 24-48 hours. Subsequent operations are usually performed on an outpatient basis.

After the surgery, patients may expect one or two additional operative procedures to further improve the shape of the nose and improve airflow through the new nasal lining.

Potential Complications

Swelling and bruising after the reconstructive surgery is common but resolves within 1-2 weeks.

As with any surgical procedure, there is a risk of infection and this risk is increased in the cocaine nose. If the patient continues to use cocaine after the surgical procedure, the damage to the new nose may be worse than it was before creating a challenging or impossible condition for surgical remedy.

Are you a Candidate?

The best thing to do before researching surgeons and treatment options is to stop your cocaine use. If the damage to your nose is so severe that you are having trouble breathing, smelling, tasting, blowing your nose, or can feel or see the hole(s) in your septum, you are a likely candidate for treatment. A consultation with Dr. Walton will establish the severity of your nasal deformity and the various treatment strategies that might be available for reconstruction.

Cocaine Nose Repair FAQs

How long will the procedure last?

This depends on the severity of the deformity and can vary from 1-2 hours to 8-10 hours.

What can I expect after the procedure?

For the microsurgical flap procedure, patients will likely be in a special care unit for a day or two after the procedure so that the flap circulation can be closely monitored. After that, they will stay in the hospital for 1 to 2 days. Pain, swelling, and bruising may occur but are usually minimal.

Are there risks?

As with any major surgical procedure, this type of reconstructive surgery carries with it some risks. Infection, internal scarring, and the need for additional procedures may occur. A more complete list of the risks and expectations will be provided during your consultation with Dr. Walton.

How soon can I return to work?

For smaller nasal procedures done on an out-patient basis, patients can usually return to work several days following their surgery depending on work requirements and exposure risks. For nasal reconstructions requiring microsurgical transfer of tissue to restore the damaged nasal lining, patients usually recuperate at home after hospital discharge for an additional 2-3 weeks before returning to work. You should consider, however, the nature of your job. For example, if you have a fairly sedentary office job, you may be able to return to work sooner than if you have a more physically demanding job. Dr. Walton will advise on the most appropriate timing of your return to the mainstream.

Although it has been mentioned already, one of the most important things that you can do to ensure a speedy, healthy recovery and surgery is to stop cocaine use as soon as possible if you have not already done so.

Next Step

For an appointment, please call Chicago Plastic Surgery, LLC office at 312-337-7795, or contact Dr. Walton by filling out our online form. We look forward to meeting you and helping you overcome cocaine nose.