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.
