One of the topics discussed at the recent AAFPS Masters Symposium on Functional and Aesthetic Rhinoplasty that was really interesting and a little left of centre (which I always love!) was the harmful effects of cocaine usage to the nose. Whilst we consider drug usage bad for our mind and bodies in general (including the skin, hair, internal organs, cancer, etc.), this was an insight into a side effect of cocaine use not everyone thinks about and is more common than it should be.
There are several consequences of snorting drugs through your nose. They can include:
- Epistaxis (nosebleeds)
- Chronic Infections (congestion/discharge)
- Perforated Septum (hole in the nasal septum)
- Nasal Collapse
- Anosmia (Loss of Smell)
- Nasal Deformity
- Nasal Obstruction
- Nose Whistling
Septal perforation (where there is a hole in the nasal septum) can cause bleeding, discharge and “whistling” during breathing. It can only be fixed with surgery and reconstruction of the nose. Excessive cocaine use is a major cause of septum perforation due to the snorting of the drug triggering the blood vessels in the nose to constrict; meaning supply of blood (and therefore oxygen) to the inner lining of the nose is reduced. When the blood is unable to circulate through the nose’s blood vessels correctly it eventually causes the septum (nose) lining to die. This lining is what supports the nose cartilage and when it is damaged leads to a hole/s and a subsequence collapse of the whole nose structure.
Signs of an imminent nose collapse are nosebleeds, congestion discharge, infection and other things that could be confused with a common cold. Not only that, but because the nose and throat are so connected your voice can be affected too.
We asked Dr Damian Marucci, Plastic and Reconstructive Surgeon from Kogarah in NSW, who was at the Rhinoplasty forum in Sydney last weekend, the issues involved with reconstructive surgery for someone with a collapsed nose from excessive cocaine use.
Dr Marucci, approximately how many patients would you see for a collapsed nose after excessive drug use?
Nasal collapse is a huge cosmetic and functional problem, and thankfully, I only see a few a year.
Do all nose reconstructions for excessive drug use work and can there be any unfixable lasting effects?
Rhinoplasty for the cocaine nose is extremely challenging! These patients tend to have large septal perforations which may be too large to fix. In terms of rebuilding the structure of the nose, often extra cartilage is required for support. This is usually taken from the rib cage. The goal of surgery is to have a supported nose which the patient can breathe through and hopefully looks acceptable. Noses reconstructed with rib tend to be “stiffer” to feel and wider than the ideal nose, but that is the tradeoff for a stable long lasting result.
Dr Marucci, what is the worst case you have ever seen?
I saw one patient with a huge septal perforation with a nose that had no support at all. He looked like a boxer. Despite this, the patient was still using cocaine and so I didn’t operate on him!
What advice would you have for someone requiring this type of surgery?
Giving up cocaine is the best thing you can do for your health. Rhinoplasty after cocaine use is a big undertaking. It will involve scars on the nose and often elsewhere. The nose can be strengthened and the breathing improved. The recovery and swelling can take many months to subside but, in the right hands, the results can be rewarding for patient and surgeon.
If you would like more information on Dr Damian Marucci see his listing on our website here, or if you would like to arrange a consult you can phone his surgery directly on 02 9588 6374.