Plastic surgery warning as number of patients with 'coke nose' rises

Doctors in the UK are raising alarms about a growing health issue linked to cocaine use—damaged noses, often called 'coke nose'. This condition involves severe, sometimes permanent harm to the nasal septum caused by the drug's effects. Experts say that even those who only use cocaine occasionally can end up with holes in their noses due to reduced blood flow, which damages the tissues. The UK's National Crime Agency estimates that around 117 tonnes of cocaine are consumed annually, a huge surge in use that places Britain as the country with the second highest cocaine consumption rate worldwide, with about 2.7% of adults reportedly using the drug. Thomas Jacques, a consultant ENT surgeon at The Cadogan Clinic in London, explains that cocaine causes the blood vessels inside the nose to contract sharply—a condition known as vasculitis. This can lead to inflammation and tissue death in sensitive users or those who frequently take the drug. Symptoms can range from minor sniffles and congestion to more serious issues like bleeding, crusting, and whistling when breathing. Some people might not even realize they have nasal damage until it becomes severe. For heavy users, the damage can extend beyond the septum, leading to a collapsed nasal bridge, or “saddle nose deformity”, and in rarer cases, destruction of the skin between nostrils or holes in the roof of the mouth. The condition isn’t limited to any particular social group; patients come from all walks of life, genders, and ages. Cases have been publicized by figures like Paris Jackson and Daniella Westbrook, both of whom have revealed nasal damage linked to cocaine use. Jacques emphasizes that damage can occur even with recreational, infrequent use, and there is no safe level of cocaine consumption. Once damage occurs, treatment options exist but are complicated and not always successful. Surgery to repair perforations in the nasal septum has a success rate of 70 to 80 percent, due to the delicate blood supply in the area. Treatment varies depending on the severity of the damage. For some, nasal irrigations and topical creams combined with complete cessation of cocaine use may be enough. In other cases, a septal button—a small silicone disc—can be inserted to block holes and stop crusting or whistling. More complex surgeries, including reconstructive rhinoplasty to fix saddle nose deformities, can cost up to £15,000 privately, though some treatments are available on the NHS. However, surgeons stress that patients must stop using cocaine entirely before any repairs can be attempted. Many people affected by this condition experience feelings of shame and stigma. Dr Jacques notes the importance of a non-judgmental approach to patient care, reassuring patients that their condition doesn’t need to be publicly known. With cocaine use rising sharply across the UK, the medical community urges greater awareness about the risks of nasal damage associated with the drug. Prevention through education and complete avoidance remains the best course of action, as fixing the damage is often complex, costly, and only partially successful.