Nose surgeon explains key signs of 'cocaine nose' and how to fix it

A nose surgeon has warned that even occasional cocaine use can cause long-term 'coke nose', a term used to describe damage to the nose.

Cocaine reduces blood flow and irritates the tissues inside the nose, which can lead to inflammation, infections and severe tissue damage over time.

Dr Lexie Wang explained on her TikTok page (@drlexiewang) that 'certain drugs, when you use them a lot or even not too much', can cause long-term damage to your nose.

"It can create something called a septal perforation or a hole on the inside of your nose," the facial plastic surgeon said.

"It's not the end of the world if you do have one. Sometimes people have them and they don't even know why.

"Sometimes it's a side effect of surgery, if you got a septoplasty, and it can just be completely asymptomatic."

Worst case scenario

"But worst case scenario is you might have some issues with bleeding from your nose, feeling like it's obstructed when you try to breathe in, maybe even a whistling sound when you go when you inhale," Dr Wang added.

"And even the worst case scenario is if you have a giant hole and it eats away at the septum completely, you can get what's called a saddle nose which is when the entire architecture and structure of the nose collapses in and looks like a horse saddle."

If you have coke nose and don't want surgery

She noted that if you 'just have a perforation and you're completely asymptomatic there's nothing to do'.

"If you do have some issues like the epistaxis, the whistling, and you don't want to do surgery, the easiest option is just to make sure that you keep the nose moisturized because that will help decrease the crusting and things like that," Dr Wang suggested.

"If you do feel like it's causing you some problems and you don't want to do a giant surgery you can always get what's called a septal button, which is when they will put something in there to block off the hole and make it seem as if you don't have a hole in there.

"But if you do want to have it repaired, there are surgeries where we can go in and basically put some new lining in there to repair and fix the hole. But it's a little bit complicated."

However, for patients suffering from a collapsed nose, reconstruction can be extensive.

“Almost inevitably, you're going to need more cartilage — i.e. rib cartilage — to build up the entire dorsum of the nose again,” Dr Wang added.

Symptoms of coke nose

• Blocked or stuffy nose
• Frequent nosebleeds
• Pain or burning in the nose
• Loss of smell
• Crusting and scabbing
• Hole in the nasal septum
• Collapsed nose

What causes coke nose?

• Reduced blood flow: Cocaine narrows blood vessels, which means less blood reaches the tissues inside the nose. Without enough oxygen and nutrients, the tissue can start to die.
• Constant irritation and swelling: Snorting cocaine repeatedly irritates the lining of the nose. Over time, this causes ongoing inflammation and damage to the soft tissue and cartilage.
• Toxic effects of cocaine: Cocaine itself is harmful to cells. Direct contact with nasal tissue can damage and kill cells inside the nose.
• Harmful substances mixed with cocaine: Street cocaine is often mixed with other substances, such as powders or other drugs. These additives can make the damage to the nose even worse.

If you want friendly, confidential advice about drugs, you can talk to FRANK. You can call 0300 123 6600, text 82111 or contact through their website 24/7, or livechat from 2pm-6pm any day of the week.