The saddle nose, pug nose, or boxer nose is a type of nose deformity characterized by a distinct dip or sag in the middle portion of the nose. This ‘saddle’ can be barely noticeable or severe enough to cause breathing problems. However, the saddle nose is clearly visible in the side profile photos and selfies, and people often feel very conscious about it. In severe cases of saddle noses, there can be obvious nasal deformities that alter the shape and function of the nose. Most patients can go through their lives with a saddle nose, but corrections become necessary for some.
Saddle nose has cosmetic repercussions too. It can make your entire face look flat. You can quickly identify saddle nose with the following symptoms:
- The collapse of the nasal bridge cartilage
- Upward rotation of the bulbous nose tip
- Obstructions in breathing through one or both nostrils
- Nasal crusting which becomes chronic
- A visible horizontal crease in the lower part of the nose that looks like a dent in the nose.
- Septal perforation
- Nose bleeds
- Whistling sound during nasal flow
It is common for people with saddle noses to feel conscious about the dip in the nose, especially during picture-taking times. The excellent news is saddle nose deformity can be easily corrected. However, this repair is a highly specialized procedure as this surgery is different for every patient depending on the indicators and desired alterations.
What causes saddle nose?
The most visible indication of saddle nose is the loss of dorsal height or a noticeable degree of nasal dorsal depression. There can be many reasons for this loss of height. The septum is one of the critical parts of the nose and a central one too. It is responsible for the structural integrity of the nose. Any damage to the septum structure causes a sunken appearance of the nose. This causes many cartilage and bone defects. This deformity mainly originates because of
- Congenital reasons such as Cleidocranial dysostosis, which affects the teeth and bone, and Congenital syphilis, which is an infection passed from the mother to the child
- Trauma: Direct trauma to the nose can cause the bones to break or damage the cartilage structure. Depression in the nasal bone can also cause saddling or sagging and loss of height.
- Surgical causes: A prior rhinoplasty, a Septorhinoplasty cost in india, or changes in the septal cartilage that are not done correctly or not appropriately healed can also cause nasal deformities such as the saddle nose. Septorhinoplasty in young patients can also cause a collapse of the nasal septum because the septum is weak and collapses as it grows. Removing too much septal cartilage is another reason for saddling.
- Over reduction of the dorsal hump: Surgical removal of the camel-shaped shape on the nasal bridge can also cause depression in the middle of the nose.
- Poorly done rhinoplasty to correct nasal contours, which causes over the projected nasal tip, or a supra tip correction, can make the nose appear saddled.
- Down syndrome
- Normal variation
- Infections
- Illness caused by medical treatment
- Medical causes such as leprosy, syphilis, recurring infections in the tissues, Wegener’s Granulomatosis, and Relapsing Polychondritis. Syphilis can also cause severe cartilage damage.
- Accidents
- Septal hematoma and septal abscess, which cause the normal blood flow to the septum to be obstructed, can also cause a saddle nose deformity.
- Cocaine abuse: Long-standing use of cocaine leads to a deficit in blood flow in the septum, which causes it to become weak and eventually collapse. The chronic use of intranasal decongestant sprays also causes this safe effect.
Saddle nose rhinoplasty includes both camouflage and reconstruction treatments. In most cases, saddle nose deformity is acquired, and its manifestation depends on individual, racial, or genetic characteristics. Trauma and iatrogenic causes are the two most common causes of saddling.
Types of saddle noses
Treating or correcting saddle nose deformity begins with correctly categorizing its severity. This classification is based on the anatomic issues causing saddle nose and include
- Type 1 has dorsal nasal depression, but the lower third of the nose has normal tip projection.
- Type 2 which has moderate to severe depression with a prominent lower third of the nose upturn
- Type 3 with moderate to severe dorsal depression loss of tip support, and visible structural deficits
- Type 4 with severe normal depression and loss of structural support to the entire nose.
Type 2,3 and 4 deformities cause difficulties in breathing too.
Saddle nose rhinoplasty
Depending on the manifestation of the saddling and the investigation into the exact nature of deformity and dysfunction help the surgeon select the best reconstructive options to correct the deformity: these address both the aesthetic and functional aspects.
Diagnosis
This is done by taking in the patient’s complete history and doing a physical examination. This helps the surgeon figure out the etiology of the deformity. The doctor will also ask about any history of nasal airway obstructions, past nasal traumas, nasal surgeries, history of autoimmune diseases, etc. if the patient has been using cocaine, then it needs to be investigated too.
The physical examination includes the degree of the location of the saddle, the condition of the nasal septum, the state of nasal valves, and the structural stability of the nasal support structures. Both imaging and diagnostic tools are used for this.
Treatment
There are two parts to the treatment. One is medical, which is aimed at containing the progression of saddling. Patients suffering from diseases such as Wegener granulomatosis and relapsing polychondritis need the intervention of medical specialists to help improve the condition.
The second part is surgical rhinoplasty or nose job that corrects the saddle nose defects. This nose surgery is done to add or restore strength to the cartilage at the base of the nose. Saddle nose rhinoplasty is one of the most complicated nose surgeries because it requires a carefully crafted graft to be placed in the nose and planning of anatomical reconstruction of the other structures.
In case of mild saddling, getting a proper graft from the septum or conchal cartilage might be possible. However, in case of greater severity of the deformity, the surgeon will recommend taking cartilage from the ribs or using artificial cartilage. In grafts obtained from external sources, the following criteria should be met.
- They should be noncarcinogenic.
- Nonallergenic
- Nonimmunogenic
- Non-destructive to the adjacent tissue and integrable
- Non-resorbable for durability
- Easy to mold, remove, and work with
- Should feel similar to the actual cartilage and have the same strength
- It should be readily available
- Cost-effective
- Zero extrusion rate.
The suitability of the graft will depend on the degree of saddling. The choice of material and type of reconstruction plays an important role and saddle nose deformity correction. There is no one ideal nasal implant. Each implant has its only successes and failures; your doctor will be the best one to decide which will suit your problem.
Rhinoplasty for saddle nose corrections takes about 2-3 hours to complete. The grafts are carefully shaped and sterilized first. Then the surgeon will make an incision along the columella of the nose and lift the skin. Finally, the graft is placed, and other structural corrections are done per the treatment plan.
Who can get saddle nose surgery?
A healthy patient bothered by the saddle nose opts for this rhinoplasty surgery. However, some persons with contraindications include
- Patients with autoimmune conditions in whom the damage can be continuous
- Intranasal drug abusers who have failed sobriety
- Unhealthy patients and those with a poor risk profile, such as schizophrenia patients.
- Patients who have unrealistic expectations
This rhinoplasty is also not recommended for people who
- I have had some previous rhinoplasties
- Have a history of smoking
- Are 16 years or younger
- Patients who are likely to experience nasal trauma such as boxers, martial artists, etc.
Saddle nose surgery recovery
Mild swelling and bruising are expected after the surgery but will decrease in 10 odd days. You should take great care of your nose and avoid blowing or sneezing through it. Don’t try to touch the nose too often or pull or tug at it. The full results appear as the skin heals, and you can see complete healing in one year of surgery.
Saddle nose surgery cost
Saddle nose surgery is one of the most challenging nose deformities to correct for the surgeon. The correct surgical approach is essential, which can have a physiological impact on the patient. The cost of saddle nose surgery in India depends on the graft type used and the surgical approach used.
Other factors that influence the price of this type of rhinoplasty are the surgeon’s expertise, the hospital cost price, the location of the clinic, and the post-operative consultations. Since it is mainly done for functional reasons, the cost of saddle nose rhinoplasty is usually covered by insurance.