Saddle nose deformity is a shape of the nose that looks like there is a dip in the nose bridge from the side profile. It is also called as pug nose, or the boxer nose. A noticeable dip in the middle portion of the nose is very visible ins selfies especially and most people feel self-conscious about it. A saddle nose is characterized by a flattened or collapsed nasal bridge, resulting in a concave appearance of the nose.
In some people, this dip is barely noticeable and hardly causes any issues but in some the collapsed nasal wall can cause severe breathing issues necessitating immediate corrections. There are two types of classification for the saddle nose
The first is based on the severity of the saddle:
- Mild saddle nose deformity where the nasal bridge is slightly depressed but does not significantly affect the overall nasal appearance.
- Moderate saddle nose deformity characterized by a noticeable depression of the nasal bridge, resulting in a concave appearance.
- Severe saddle nose deformity with a marked collapse of the nasal bridge, causing a significant visible concavity and deformity of the nose.
The second classification considers both aesthetic and functional aspects of saddle nose formation.
- Aesthetic deformity without functional impairment. The nasal bridge is depressed, resulting in a concave appearance, but there is no significant nasal obstruction or breathing difficulties.
- Aesthetic deformity with functional impairment. Along with the depressed nasal bridge, there is also nasal obstruction or breathing difficulties due to structural abnormalities, such as septal deviation or collapse of the internal nasal valves.
- Traumatic deformity. This type occurs as a result of trauma, such as nasal fractures, leading to a saddle-shaped depression of the nasal bridge.
- Inflammatory deformity. It includes cases where saddle nose deformity develops as a result of inflammatory diseases or complications from previous nasal surgeries.
When the saddle nose is only because of the bridge collapse, the skin of the tissue is towards the inside of the nose. If there is any injury to the nose it can also cause the bones to depress. On the other hand, when the damage to the bone, cartilage, and septum is acute then it can affect the tip of the nose and cause scarring. In such conditions, the nose tip can rotate upwards leading to a pug nose-like appearance.
The classification of the saddle nose deformity helps the plastic surgeon assess the severity of saddle nose deformity and guide treatment decisions. The appropriate treatment approach will depend on the specific classification, underlying cause, and individual patient factors.
Saddle nose deformity causes
Loss of dorsal height or a degree of nasal dorsal depression are two common indications of saddle nose deformity. The septum of the nose is responsible for the structure integrity of the nose and damage to the septum, or the bone can cause loss of height in the middle portion of the nose creating a concave dip. This may be caused because of
- Trauma: Nasal trauma, such as a severe blow to the nose or nasal fractures, is a common cause of saddle nose deformity. The impact can damage the nasal structures, including the septum and nasal bones, leading to a loss of support and collapse of the nasal bridge.
- Nasal Surgery: Previous nasal surgeries, particularly those involving the septum or nasal dorsum, can occasionally result in saddle nose deformity. Complications from these surgeries, such as excessive removal of cartilage or inadequate structural support, may contribute to the deformity.
- Congenital or Genetic Factors: Some individuals may be born with a predisposition to saddle nose deformity due to genetic or congenital factors. Certain genetic conditions or syndromes such as Cleidocranial dysostosis and Congenital syphilis can affect the development and structure of the nose, leading to a weakened or deficient nasal bridge. A small, mushroom or big nose can also give a saddle-like appearance to the nose.
- Inflammatory and Autoimmune Diseases: Certain inflammatory conditions, such as granulomatosis with polyangiitis (formerly known as Wegener’s granulomatosis), relapsing polychondritis, or systemic lupus erythematosus (SLE), can cause damage to the nasal cartilage, leading to saddle nose deformity.
- Cocaine Use: Chronic and excessive use of cocaine can damage the nasal structures, including the septum and supporting cartilage. Prolonged cocaine abuse can lead to necrosis (tissue death) of the nasal septum and collapse of the nasal bridge, resulting in saddle nose deformity.
- Septal hematoma and septal abscess
Rhinoplasty for Saddle Nose Deformity
Top plastic surgeons evaluate your specific case, identify the underlying cause, and recommend appropriate treatment options to address the deformity and improve nasal function and aesthetics. There are many indications or symptoms of saddle nose including
- Upward rotation of the nasal tip
- Collapse of the cartilage in the bridge
- Breathing problem in one or both nostrils
- Chronic Crusting in the nose
- A horizontal dent in the lower portion of the nose
- Septal perforation
- Frequent nose bleeds
- Sounds coming from the nose during nasal flow
Using the simple and complex rhinoplasty procedure the saddle nose deformity can be easily corrected. Saddle nose rhinoplasty is a highly individualized procedure and is different for each patient based on their symptoms and causes of saddle nose. During the consultation, the plastic surgeon will do a thorough diagnosis of the nose and check for any obstructions in the nasal airways, the effect of past nasal traumas, nasal surgeries, and any history of autoimmune disorders if any.
If the saddle nose is caused because of drug abuse then the patients need to go in a detox and rehabilitation program before qualifying for a saddle nose rhinoplasty.
Another important part of the treatment is the medical side, in which diseases such as Wegener granulomatosis and relapsing polychondritis are first treated to improve the conditions triggering the dip in the nose before moving on to surgical intervention. It is important to consult with a qualified healthcare professional or a plastic surgeon if you suspect or have been diagnosed with saddle nose deformity.
Surgery or complex rhinoplasty for saddle nose deformity
The surgery for saddle nose correction is very precise and needs great expertise on the part of the plastic surgeon. The surgeon needs knowledge and expertise in advanced Rhinoplasty techniques for successful results.
Cartilages harvested from the patient’s own body or manufactured artificially are used to provide the necessary support to the nasal bridge and straighten its appearance. The cartilage has to be trimmed and crafted carefully under the nose before the reconstruction of the supporting structures. The graft can be obtained from the septum or the ear of the patient. If a large number of grafts are needed then the cartilage is taken from the ribs of the patient.
- In the case of synthetic grafts, they are made of are often made of silicone or porous polyethylene (Medpor). They are designed to mimic the natural shape and contour of the nasal bridge and provide support to correct the saddle nose deformity.
- Other types of grafts used in saddle nose deformity repair are Hydroxyapatite Grafts which closely resemble the mineral composition of natural bone. It can be shaped and implanted as a graft to restore the nasal bridge. Over time, the hydroxyapatite graft integrates with the surrounding tissues, providing long-term support.
- Polyethylene grafts are flexible and malleable implants that can be used to reshape and augment the nasal bridge. They provide stability and are easily customizable to match the patient’s individual needs.
Patients who are suffering from tip rotation because of saddle dip need more extensive cartilage harvesting and a longer draping to correct the deformity. The graft needs to be stable enough to give strength and support to the bridge as well as the tip of the nose. Hence the selection of graft depends on the amount needed, the degree of saddling etc. The grafts are carefully shaped and sterilized before placing in the nose.
Using the grafts to augment the dorsal height is also known as dorsal augmentation. The entire surgery takes about 2-3 hours to complete and is done under anesthesia. The incisions are made along the columella of the nose to lift the skin up. The grafts are placed to even out the height and clear the nasal pathway obstructions. Once satisfied the surgeon will then drape the skin over the graft and tissues and close the site with incisions.
Saddle nose surgery recovery
Immediately After Surgery: You will likely experience some discomfort, swelling, and bruising around the nose and possibly the eyes. Your surgeon may place a splint or cast on your nose to provide support and protect the newly reshaped structures. Pain medication and cold compresses can help manage any discomfort.
First Week: Swelling and bruising are typically at their peak during the first few days after surgery. It’s important to keep your head elevated, even while sleeping, to help minimize swelling. Your surgeon may recommend using saline nasal sprays or rinses to keep the nasal passages moisturized and promote healing.
Two to Three Weeks: By this time, the initial swelling and bruising should start to subside. However, you may still experience some residual swelling, especially in the nasal tip area. It’s important to follow your surgeon’s instructions regarding any dressings, splints, or nasal packing that may need to be removed.
Several Weeks to Months: Over the following weeks and months, the swelling will continue to diminish, and you will notice gradual improvements in the shape and appearance of your nose. However, it’s important to remember that complete healing and final results can take several months to a year, as the tissues continue to settle and refine.
During the recovery period, it’s crucial to follow your surgeon’s post-operative care instructions, which may include:
- Taking prescribed medications, such as pain relievers or antibiotics, as directed.
- Avoid strenuous activities and exercise that could increase blood pressure and strain the healing tissues.
- Avoid nose blowing and take precautions when sneezing to protect the nasal structures.
- Keeping the nasal area clean and avoiding irritants.
- Attending follow-up appointments with your surgeon for evaluation and monitoring of your healing progress.
- Avoid wearing sunglasses on the nose
- Make sure you wear sunscreen to protect the skin and heal.