We Performed Complicated Revision Rhinoplasty For "Coke Nose"

Correcting The Cocaine Related Nasal Deformity

We performed a complex open-technique revision rhinoplasty on a patient who had previously undergone rhinoplasty at another clinic and subsequently developed significant deformities in the nasal tip and bridge due to cocaine use. Structural reconstruction was performed using autologous rib cartilage and temporal fascia grafts to restore nasal support, contour, and symmetry. This case illustrates the challenges of revision rhinoplasty in patients with compromised nasal tissues and structural deficiencies following previous surgery and cocaine-related nasal damage.

A patient who had previously undergone rhinoplasty at a different clinic and subsequently developed septal perforation followed by collapse-like deformities on the nasal bridge and tip due to cocaine use, presented to our clinic for treatment. A very large septal hole, 6-7 cm in diameter, was observed inside the nose. The patient was advised to stop using cocaine.

The patient was advised to undergo nasal lavage with seawater, adopt a Mediterranean diet, avoid cigarette smoke, restrict salty foods, and increase oral water intake following cocaine use. Surgery was planned after it was observed that the nasal mucosa had returned to health. Simultaneously, a procedure to reduce the size of the nasal septum perforation was also planned for the patient.

A more comprehensive second operation was planned for the patient to repair the septal hole inside the nose (usually, in cases with small septal holes, we plan both septal perforation closure and rhinoplasty operations at the same time).

Patient's Pre-Nasal Surgery Examination Findings

The images below illustrate the patient's problems outside of the nose.

The image above shows collapse and indentation in the terminal nostril and nasal valve region (retracted ala and nasal valve collapse).

The image above shows areas of skin depression, more pronounced above the last nostril. Unfortunately, these problems arise because the patient has largely lost the cartilage support at the tip of the nose.

The image above shows a retracted ala and a collapse in the left nostril.

The image above shows a collapse in the left nostril and supratip area. The patient has begun to develop a "saddle nose deformity".

The image above shows a backward deviation and loss of projection at the tip of the nose, along with a collapse in the supratip region and the beginning of columella retraction.

Surgical Technique

An open rhinoplasty operation was planned for the patient. A cartilage graft was prepared from the patient's right rib. Due to significant mucosal and cartilage support loss within the nose, temporal fascia was harvested to cover the remaining cartilage grafts inside the nose and protect against possible infection.

The image above shows "Harvesting Costal Cartilage". Two grafts were prepared from the patient's rib cartilage. The graft area was closed with aesthetic skin sutures and bandaged. The cartilage grafts were prepared using the optical incision technique.

The image above shows "Harvesting Temporal Fascia". A temporal fascia graft was obtained from the patient's temple area to cover the cartilage grafts placed there. The incision site in the scalp was sutured and a pressure bandage was applied to the head.

During the preoperative endoscopic nasal examination, when the endoscope was inserted into the patient's nose, it was observed that the light was reflected very clearly from the outside, and it was thought that only very thin skin and cartilage tissue remained. During the operation, it was also seen that most of the alar cartilage and caudal septum had eroded due to cocaine use.

Cocaine Nose Reconstruction Surgery Before and After Images

Below are before and after images of an open rhinoplasty operation performed to treat cocaine-induced nasal damage using rib cartilage and temporal fascia. Most of the problems in the patient's nasal tip and bridge have been corrected.

You can read articles related to "cocaine nose" prepared by Dr. Murat Enöz and published on this website via this search result link (you can see the articles by clicking on "more posts" at the end of the page) >> https://www.ent-istanbul.com/search?q=cocaine+nose

Source links >> A New Cocaine Abuse Complex: Involvement of Nose, Septum, Palate, and Pharynx | JAMA Otolaryngology–Head & Neck Surgery | JAMA Network / Nose Damage from Drug Use: Impact of Snorting Drugs on the Nasal Passages / Extensive Sinonasal and Oropharyngeal Necrosis as a Consequence of Adulterated Cocaine with Mimicry of ANCA-Positive Vasculitis - Adnan S. Hussaini, Cara K. Black, Sonya Malekzadeh, Gregory J. Milmoe, 2019

Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon

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