Introduction: Cocaine is known to cause necrosis of the soft tissues secondary to its vasoconstrictive effects, which has negative functional and cosmetic outcomes of the midface and adjacent structures. To our knowledge, cleft lip caused by cocaine use has not been described in the literature.
Case presentation: A 52-year-old man presented with a deformity of the lip and nasal sill, septal perforation, and hard palate fistula secondary to long-term cocaine use. The patient underwent lip reconstruction using a modified Millard technique and had a lasting favorable cosmetic outcome more than 5 years after surgery.
Discussion: We report a case of cocaine abuse causing cleft lip, and successful reconstruction with a modified Millard technique.