Cocaine Nose Reconstruction

Nasal reconstruction is paramount for restoring loss of nasal aesthetic and/or function following trauma, cancer, and other malignancies. Amongst the causes, excessive cocaine use can demand more challenging, multi-staged reconstructions. 

This patient’s reconstruction was performed using autologous cartilages (harvested from his temporalis muscle, ear, and rib). The key component of his reconstruction was restoring foundational support lost with a massive septal perforation and collapse of the middle vault. Rib cartilage was used to create sound support. A diced cartilage and fascia graft overtop the new framework restored dorsal height.
Watch Dr. Jay Calvert and his colleagues detail this patient’s story and operation on The Doctors TV

Consequences of Cocaine Use on the Nose

Nasal vasculature is directly harmed when cocaine is insufflated through the nose. The vasoconstrictive effect is forceful on the delicate vessels and restricts the amount of blood and oxygen supply to the lining of the nose. Subsequently, the underlying structures become compromised. The most imminent sign of devitalization damage is of the septum, which results in a septal perforation. The symptoms range to a large degree. However, many do not recognize the damage cocaine is causing until the septum weakens to the point of obvious collapse of the nose. Also, continual insult to injury poses a high risk of infection that corrodes the septum. Clearly, when the central support is eliminated, the nose sinks in and forms what is called a “saddle nose.” Damage caused by continued use of cocaine can and will pervade to the sinuses, cartilages, and skin. 

Treatment

The severity of damage caused by cocaine abuse will inform the course of surgical reconstructive treatment.

If intervention occurs at an early stage of damage, repair is likely to be successful with a single staged surgery. For example, this could present as a small septal perforation. However, in cases which the lining of the nose is friable, the septum is absent, the external skin and columella is necrotic, etc., reconstruction to restore restoring a fairly “normal” appearance and function is immensely more difficult. Particularly, a common problem is loss of the columella. This requires a forehead flap to recruit tissue with a healthy blood supply for replacement. Notably, if the floor of the nose does not provide a healthy bed for the forehead flap to latch to, a more complex grafting reconstruction is first required. A reconstruction as such would require multiple surgeries.

Regardless of the severity of the coke nose condition and course of treatment, the patient absolutely must be committed to discontinued cocaine use. 

For more information on nasal reconstruction, check out the Beverly Hills Plastic Surgery Podcast on Apple Podcasts or Spotify.