Septoplasty: septal perforation from drug use how dr Rizk can help

A septal perforation is a hole in the septum, which is the structure comprised of bone and cartilage between the left and right nasal cavities. Septal perforations occur when the cartilage dies due to a reduction in blood supply to the septum. Many things can cause this reduction in blood supply, including regular use of drugs, namely cocaine.

Septal Perforation from Drug Use

Cocaine can severely damage the function and appearance of the nose. The drug is a vasoconstrictor that thins the blood, which can cause the lining in the mucous membranes to dry out and die. Death of the mucous membrane lining compromises the support of the cartilage beneath it, in turn causing the cartilage to die which leads to a hole in the septum (septal perforation). Since the septum is what provides structural support to the nose, a perforation can cause the nose to collapse. Note that a septal perforation cannot heal on its own without treatment.

Usually, cocaine users notice the early signs of a septal perforation, but in many cases they are unaware of how dangerous it is since these signs are often very similar to other harmless conditions like nasal congestion, allergies, minor nosebleeds, rhinorrhea (nasal discharge) and sinus infection. Many cocaine users miss the window to receive treatment in time to reverse early damage from cocaine use, and as a result it leads to a septal perforation.

How to Get Help

If you believe you may have a septal perforation that was caused by drug use, you need to take action. The first and most important thing to do is stop doing cocaine immediately. Addiction is not your fault, but if you have a septal perforation caused by cocaine this means your drug use is causing you major health problems. Realize the problem before more tissue dies and the nose collapses. Enroll in a rehab program as quickly as possible.

Next, start looking for a nose surgery specialist (see Hire an Expert below) who can help assess the condition of your septum and advise you as to whether you are a candidate for septal perforation surgery. You need to be completely clean and unlikely to relapse before you are cleared for surgery, as any additional drug use may reverse the effects of the surgery.

Treating a Septal Perforation

Generally speaking there are two types of treatment for a septal perforation: medical treatment or aesthetic repair. The goal of medical septal perforation treatment is to moisten the inside of the nose, usually with saline spray, a gel or an ointment such as Borofax that prevents the growth of bacteria.

If the medical approach doesn’t work, septal perforation surgery is usually the only remaining option. This highly complex surgery requires rebuilding three separate areas of cartilage and mucous membranes. The cartilage is usually taken from the patient’s rib or ear. Skin grafts may need to be necessary as well. It is difficult to guarantee sufficient blood supply to the reconstructed area, and therefore success rates for septal perforation surgery are relatively low (40-60%). As result, the procedure should only be performed when medical management has proven unsuccessful or in case of severe aesthetic deformity.

It should be noted that the chances of success are higher with smaller perforations. Also, patients that are not cocaine users tend to have better success with treatment. For example, when a septal perforation leads to an external saddle nose deformity, it can often be successfully repaired with grafts from the ear or from a rib bank. Usually, a saddle deformity or collapse of the external bridge of the nose occurs in the cartilage part of the bridge, right above the tip; this is called a cartilagenous saddle nose deformity.

Hire an Expert

Due to the fact that a septal perforation means that some tissue has died, the tissue surrounding the perforation becomes delicate and must be treated with extreme care. It is very important to preserve as much of the remaining tissue as possible.

Therefore, it is imperative that you find a surgeon with in-depth knowledge of the nasal structures. Your surgeon should have experience operating on the nasal structures and should have both training in and experience repairing both aesthetic and functional issues, such as breathing problems. To increase your odds of finding a topnotch surgeon, look for a board-certified facial plastic surgeon that specializes in procedures of the nose.

Dr. Rizk carefully assesses each patient, taking into account both physical and psychological considerations. He will not perform a reconstructive procedure on anyone who is still using drugs or likely to relapse. Before moving forward with surgery he needs to be fully convinced that the patient is clean and intends on remaining clean, because any relapse can reverse the effects of the repair.

To learn more about getting treatment for a septal perforation caused by drug use, contact Dr. Rizk today.


Sam Rizk, MD

By Dr. Sam S. Rizk, M.D., FACS.

Dr. Rizk is a double board-certified facial plastic surgeon who specializes in rhinoplasty surgery and a recognized expert on the latest advances in facial plastic surgery techniques. He performs a range of facial plastic surgeries at his New York practice.

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