For Alan Brown, it was the final, horrific sign his cocaine habit had spiralled out of control.

Catching sight of his reflection, he clearly saw the damage from snorting lines of the class A drug: his nose was collapsing.

A hole had formed in the cartilage between his nostrils and it was now so big that his nose was lopsided and deformed.

‘It was clearly visible,’ says the 44-year-old from London. ‘A symbol of everything going wrong with my life. I knew I needed help.’

Some of that help came from a world-renowned surgeon who performed an extraordinary operation to rebuild Alan’s cocaine-ravaged face.

Anil Joshi – a plastic surgeon and ear, nose and throat specialist – used a sliver of rib, plus tissue from behind Alan’s ear, to reconstruct his crumbling nose.

In an amazing turnaround, the surgery has also helped Alan rebuild his life. Now surgeon and patient are warning about the dangers of even small amounts of cocaine.

Although Alan’s experience seems extreme, according to Mr Joshi, ‘cocaine nose’ is increasingly common.

Worryingly for the 1.5 million Britons who take the drug, cocaine can harm a user’s nose after just a few lines.

‘When I examine patients’ noses,’ the surgeon says, ‘I can immediately separate cocaine users from non-users. Even if they swear they’ve never used cocaine, I can tell if they’re lying. The evidence is obvious.’

What begins with sores, scabs, crusting and inflammation can escalate until the damage becomes irreversible.

He says: ‘With some patients I’ve seen, it’s almost unbelievable. They’re walking around like zombies with a cavity where their nose used to be. Surgically, there’s nothing we can do. The only option is prosthesis: an artificial nose.’

It’s a nightmarish vision far removed from cocaine’s image as a glamorous party drug.

Extracted from the coca plant, it stimulates the central nervous system and, although illegal, is taken recreationally – snorted in powder form – to produce a short-lived burst of confidence, energy and euphoria.

In 2023 the Organisation for Economic Co-operation and Development (OECD) reported Britain had the world’s second highest rate of cocaine use – behind Australia but above Mexico and Colombia – with around one in 40 aged 15 to 64 using the drug.

Highly addictive, cocaine can also produce psychological side effects including restlessness and paranoia. It also wrecks the physical structure of the nose.

Although cocaine is itself harmful, the drug is also frequently cut with other chemicals which can damage the nose and lungs when inhaled, ranging from anaesthetic medications such as benzocaine and lignocaine to caustic laundry detergent powders – and even levamisole, a white powder used by vets to treat parasitic worms.

Mr Joshi said: ‘Every week, my colleagues and I see patients with cocaine nasal problems. They’re from all walks of life. It’s more common than people imagine. They’re not oblivious to the dangers, they just get sucked into taking cocaine.’

When snorted repeatedly, the drug deadens nerve-endings in the nose, narrows the blood vessels and causes vasculitis, an inflammation of the blood vessel lining.

Mr Joshi said even a few lines of cocaine could damage the nose – but that it was impossible to determine exactly how much of the drug would cause more severe or permanent symptoms.

In its early stages, ‘cocaine nose’ causes the inside surfaces of the nose to become red and inflamed, with a build-up of crusty discharge. This inflammation can be treated with steroid nose drops.

However, the problems can quickly become more serious.

Mr Joshi said: ‘As the blood vessels narrow, blood supply becomes restricted. Over time, blood vessels close up completely and the tissues relying on that blood supply start to die off.’

The septum, which separates the nostrils, is particularly vulnerable. Made of bone at the back and cartilage at the front, it is lined with mucosa – the moist membrane which traps harmful particles as a person breathes.

With repeated cocaine use, trauma to the mucosal lining from deadened nerves and lack of blood eats away at the cartilage – creating a hole, or septal perforation. This can then cause the external ridge of the nose – the dorsum – to collapse, known as ‘dorsal saddling’.

In 2000, former EastEnders actress Daniella Westbrook revealed that an addiction to cocaine had destroyed her septum.

The 51-year-old later admitted spending more than £250,000 on cocaine during a long period of addiction early in her career. She required multiple surgeries to fix the damage done by the drug to her face.

The NHS will fix a nose damaged by cocaine if a consultant believes it is necessary.

The operation can also be carried out privately, with costs varying according to the size of the hole and the complexity of the procedure required – typically around £4,000 to £7,000, similar to a cosmetic ‘nose job’.

First, however, users must confront their drug use.

Mr Joshi said: ‘They must have a cocaine-free nose – which usually means waiting 12 to 18 months while the inflammation recedes. There’s no point performing surgery on inflamed tissue – or if the site will just be damaged again through more cocaine.’

For smaller perforations, a procedure called an anterior ethmoidal artery flap sees tissue from the back of the nose carefully lifted, with its blood supply intact, then rotated forwards to patch the hole.

But in severe cases, such as Alan’s, even more complex surgery is required.

Raised in south-east London, he started taking cocaine in his teens, but his occasional indulgence became more frequent.

He said: ‘It was fun at first – a few beers in the pub then sniffing a couple of lines and talking rubbish with my mates until dawn. But once a month became once every fortnight, once a week, then sometimes through the week too.

‘I never imagined the damage it would cause to my life – or my nose. It was a nightmare. By my mid 20s, my nose was always sore, bleeding, scabbing up. Eventually I noticed a hole in my septum. But even though I knew what was happening, I didn’t stop: I was addicted.’

To fund his habit, he did driving jobs and casual labour.

In his 30s he repeatedly tried to kick his habit – stopping for months before relapsing. He said: ‘Something would trigger me and I’d go on a bender – not sleeping for days, constantly sniffing and doing even more damage.’

His lowest point came in 2020. He said: ‘My habit went boom. I was stressed and went on a four-month binge. People noticed my nose was collapsing. I kept seeing my reflection in the mirror or in the windows on the Tube. I felt I was on death’s door, that I’d ruined my life.

‘Then I had an epiphany, a little vision from God. I suddenly realised there’s more to life and I can do this: I’m going to stop.’

Through an amazing effort of will, Alan sought counselling and distanced himself from the people enabling his drug use.

In 2022 he was referred to Mr Joshi at University Hospital Lewisham, who last month rebuilt Alan’s septum using cartilage from a donated rib wrapped in a thin layer of tissue cut from the temporalis muscle behind his ear.

The surgeon, who also works privately, explained: ‘The surgery was a marathon six hours, but the hole has been closed and the nasal structure looks beautiful, nice and strong. I’m proud of the surgery, but most importantly I’m happy to have met such a brave and inspiring individual.’

He added: ‘On a daily basis, patients walk through my door with visible damage that marks them out as a drug user. I wish people would realise the damage they’re doing to themselves with cocaine.’

For Alan, finally beating addiction and undergoing surgery have proved transformative. He now lives with his girlfriend and works as a site manager for a fire protection company.

He said: ‘You think your face is going to collapse, that people are going to judge you, that your life’s over. The surgery has been an absolute lifesaver.

‘If I could go back to being teenager, knowing what I know now, I would never have touched cocaine.’