Cocaine Nose Reconstruction
About the procedure
Long-term cocaine use is extremely damaging to the inside of the nose. Each use causes the blood vessels within the nasal lining (mucosa) to constrict, which gradually leads to thinning and deterioration of the mucous membranes. In some cases, the mucosa becomes so thin that it erodes, exposing the underlying cartilage support structures.
Once cartilage is exposed, it is prone to infection and erosion, often resulting in perforations in the nasal septum. Patients with septal perforation may experience symptoms such as whistling sounds while breathing, nasal crusting, and frequent bleeding. As the cartilage continues to erode, it weakens and collapses. This may cause saddle nose deformity, nasal valve collapse, and complete obstruction of the nasal airway.
The CT images shown below are from a patient who experienced nasal collapse due to chronic cocaine use. These images demonstrate classic findings of advanced nasal septal collapse, including the absence of septal cartilage and deformation of the external nasal structure.
CT images of a patient with nasal collapse due to cocaine use (cocaine nose)
Reconstruction of Cocaine Nose
Reconstructing a nose damaged by cocaine use is a complex clinical challenge. Before any surgical intervention can be considered, patients must stop all cocaine use. Continued use risks further damage and failure of the surgical repair.
In early-stage damage — when a septal perforation is present but the nasal mucosa remains in relatively good condition — reconstructive procedures may involve using the patient’s own nasal mucosa to patch the perforation in the nasal septum.
In intermediate cases, where a saddle nose deformity is present, Dr. Hirsch performs nasal reconstructive procedures that restore the natural contour of the nose using fascial or cartilage grafts.
With prolonged cocaine use, however, the nasal lining becomes severely scarred and unsuitable for graft support. Once the nose collapses, it must be rebuilt using cartilage grafts for structure, and a new nasal lining to protect these grafts. Dr. Hirsch reconstructs this lining by harvesting skin from the forearm and transferring it into the nose.
This technique, called a free flap, is a complex microsurgical procedure involving multiple stages. The forearm skin is shaped in advance and, during the main surgery, transferred into the nasal cavity. Blood vessels from the flap are connected to vessels in the neck to ensure survival of the tissue. Additional procedures may later be required to refine or thin the lining.
This approach allows for the restoration of both breathing and nasal form.
Rhinoplasty and Nasal Reconstruction
Rhinoplasty is a surgical procedure that improves the shape and function of the nose, addressing issues like dorsal hump, bulbous tip, or nasal obstruction. In some cases, severe damage—such as from trauma or prolonged drug use—requires advanced reconstructive techniques to restore both appearance and breathing.
Chronic cocaine use can cause cartilage erosion and nasal collapse, similar to traumatic injury. In these cases, reconstruction may involve cartilage grafting along with lining restoration. Whether for structural repair or cosmetic refinement, Dr. Hirsch customizes each rhinoplasty to achieve natural-looking results while enhancing nasal function.
Frequently asked questions about cocaine nose reconstruction:
I RECENTLY STOPPED USING COCAINE AFTER MY NOSE COLLAPSED. HOW LONG SHOULD I WAIT UNTIL I UNDERGO RECONSTRUCTION?
You must be free from all cocaine use for at least 6 months before undergoing free flap nasal reconstruction. You also must not be smoking cigarettes. The skin used to reconstruct the nasal lining is extremely delicate and requires a healthy blood supply. Cocaine and tobacco damage blood vessels and significantly increase the risk of flap failure.
WHAT CAN I EXPECT IN EACH STAGE OF COCAINE NOSE RECONSTRUCTION?
Because the blood supply to the forearm flap is delicate, several preparatory stages are needed to ensure successful healing.
- Stage 1: The nasal lining shape is drawn on the forearm, and a partial incision is made.
- Stage 2: A full incision completes the construct, redirecting blood flow.
- Transfer Stage: The flap, including skin and vessels, is transplanted into the nose. The radial artery is connected to neck vessels, and rib cartilage is used to support and stent the nose. This delicate procedure takes 8–10 hours.
- Hospital Stay: Patients typically spend 4–7 days in the hospital, including 24–48 hours in the ICU for flap monitoring.
One or two follow-up surgeries may be needed to refine the nasal lining and shape.
WHAT SYMPTOMES INDICATE THAT I MAY NEED COCAINE NOSE RECONSTRUCTION?
Common signs include nasal whistling when breathing, frequent nosebleeds, nasal crusting, visible saddle nose deformity, or complete nasal collapse. These symptoms may suggest septal perforation or collapsed nasal cartilage and should be evaluated by a specialist experienced in nasal reconstruction.
IS COCAINE NOSE RECONSTRUCTION COVERED BY INSURANCE?
Coverage may vary depending on your insurance provider and the extent of nasal damage. In some cases, reconstruction may be deemed medically necessary if there is significant airway obstruction. Dr. Hirsch’s office can assist with providing documentation for pre-authorization if applicable.
Additional resources about cocaine nose reconstruction
Feel free to browse the following links to learn more about cocaine nose reconstruction:
https://www.doctorwalton.com/procedures/nose-procedures/cocaine-nose/