How to fix a saddle nose?Ear, Nose & Throat Plastic Surgery
I'm a 38 year old female. In the past year, I've noticed that my nose has shown signs of 'saddling'. What can I do about the appearance of my nose?
Do you have a saddle nose ?
Some people are born with a slight upturn on the tip of their nose that is natural and attractive. However when this appearance becomes more pronounced, it may be described as “pug nose” or “ boxer’s nose”.
The first question to ask is : "Do you have a saddle nose ?". The nose bridge is supported by paired nasal bones and an underlying vertical cartilage known as the nasal septum. If you press on the middle part of you nose and it is very soft and collapsible, then you might have a saddle nose deformity.
What is a saddle nose ?
A saddle nose is a deformity that results when the nose bridge has a weakness that causes it to cave in. It is the result of loss of support from the septum, specifically the cartilage that makes up the septum of the nose (see below).
This usually happens in the middle of the nose bridge which causes it to look very much like a horse saddle when looking at the side-view, which led to it being described as a saddle nose deformity. The severity can range from slight, which is barely noticeable, all the way to extreme which can be disfiguring. The good news is that there are treatment options that can restore the normal profile of a saddle nose.
There are several reasons how a saddle nose can occur.
1. Trauma. One of the common causes of a saddle nose is nose injury where a nose fracture leads to a break in the septal cartilage and a collapse in the middle part of the nose.
2. Previous Rhinoplasty. This is getting more common. Rhinoplasty surgery or septoplasty procedures that are too aggressive and when excess septal cartilage is removed may lead to saddle nose deformity.
3. Medical conditions. Uncommon conditions such as automate diseases or infections of the nose can lead to destruction of the nasal cartilage and a saddle nose deformity.
4. Use of drugs. Although uncommon in our patient population, the use of both recreational drugs e.g. cocaine and nasal sprays through the nose can lead to damage of the cartilage and a collapse of the middle part of the nose.
How to fix a saddle nose?
The treatment for a saddle nose deformity would be to treat or manage the underlying cause. In cases where the saddle nose deformity is significant or when there is a difficulty in breathing, the definitive treatment would be a reconstructive rhinoplasty procedure. This should be performed by a surgeon that is experienced with treating such complex complications. The nose cartilage has to be rebuilt with autologous cartilage (your own cartilage) which may be taken from the remnant nasal septum. However, most often this is insufficient and the cartilage has to be harvested either from the rib cartilage or the ear cartilage. Using healthy cartilage, spreader grafts are use to reconstruct and reinforce the nasal septum so as to restore the stability to the middle part of the nose.
I hope this answers your question. Have a great weekend!
Dr. Terence Goh
Saddling of the nose is due to collapse of the mid vault area, or what we sometimes call the keystone area. It does not usually happen spontaneously, unless there has been previous surgery, trauma, septal perforation, cocaine use, rare autoimmune diseases or tumour growth.
A thorough nasal examination including a nasoendoscopy should be performed to identify the underlying cause.
The way to treat this usually involves reconstruction of the weakened septum using rib cartilage. Temporary measures such as using fillers or grafts to camouflage the depression can be considered but bear in mind this does not address the underlying problem of gradual collapse due to loss of support.