Saddle Nose

Saddle nose — or saddle nose deformity — is when the bridge of your nose (the middle part) sinks or collapses. It makes your nose flatter and lose some of its height. This condition gets its name from the nose’s sunken-in, saddle-like appearance. Other names for it are boxer’s nose and pug nose.

Saddle nose deformity changes the appearance of your nose. It can also cause breathing issues that may interfere with your life. Without treatment, this condition can worsen over time.

Getting treatment from a board-certified otolaryngologist (ENT) or facial plastic surgeon can help correct a saddle nose.

What are the stages?

Healthcare providers group this condition into three stages, based on how much support you’ve lost:

• Minimal saddle nose: There’s a small depression (dip) in your dorsum (the bridge of your nose).
• Moderate saddle nose: There’s a larger dip in your dorsum, and your nose looks flattened from all angles. The tip of your nose may turn upward.
• Major saddle nose: There’s an obvious lack of support from the cartilage of the middle portion of your nasal bridge, causing your dorsum to sink in. The tip of your nose turns upward.

Signs of saddle nose deformity

The telltale sign is a dip in your nasal bridge. The tip of your nose may turn upward.

Saddle nose symptoms may include:

• Nose pain or discomfort
• Nosebleeds
• Crusting around your nose
• Breathing issues
• Nasal septum perforation (when there’s a hole in the cartilage that separates your nostrils)

When a saddle nose results from an injury, you may notice a dip right away. In other cases, you may have a dip that becomes more obvious over time.

Saddle nose causes

Anything that damages your nasal septum (the cartilage between your nostrils) can lead to saddle nose deformity. This is because your septum provides support for your nose. Some people may be born with it.

Specific causes include:

• Trauma: A damaged or broken nose can cause your septum to break down. This is the most common cause of saddle nose deformity.
• Prior nasal surgeries: Septoplasty (surgery to correct a deviated septum) may lead to saddle nose deformity. This most often happens with severe cases of a deviated septum.
• Septal hematoma: This refers to a collection of blood in your septum (from injury or surgery). It can limit blood flow to your septum, leading to saddle nose.
• Septal abscess: This happens when there’s an infection and pus collects in your septum. This can also slow blood flow and cause saddling.
• Autoimmune diseases: These conditions can cause inflammation that restricts blood flow to your septum. This can weaken your septum and cause your nasal bridge to sag. Conditions that can cause saddle nose include relapsing polychondritis and granulomatosis with polyangiitis (previously known as Wegener’s disease).
• Infections: Some infections, like syphilis and leprosy, can keep your nose from getting enough blood, causing saddling. Syphilitic saddle nose is a symptom that results from syphilis.
• Substance use disorder: Snorting cocaine, methamphetamines, crushed opioid pills or other drugs can damage nasal structures and lead to saddle nose.

Complications of this condition

Saddle nose can make it harder to breathe. It can lead to chronic sinus issues and obstructive sleep apnea.

It can also make you feel self-conscious about your nose’s appearance.

Whether the issue is mostly about how your nose looks or how it works, there are treatments that can help.

How doctors diagnose this condition

A healthcare provider can diagnose saddle nose during a physical exam. During your visit, they’ll ask about your symptoms, including any breathing issues you’re having. They may take photos of your nose to document the severity of the condition.

They may ask you how you’d like your nose to look, so they can decide which treatments will work best.

Can a saddle nose be corrected?

Surgery is the most common treatment. Some mild cases may respond to dermal filler injections.

Rhinoplasty (nose job)

Rhinoplasty — also known as a nose job — is plastic surgery to change your nose’s shape and size. Surgeons use bone, cartilage and tissue grafts to rebuild your nose and restore your breathing.

Usually, this involves using autologous grafts. This means the material used to build up your nose comes from your own body. Often, surgeons use cartilage from your septum, ear or rib. They may use bone from a part of your pelvis called the iliac crest.

In other cases, they use allogeneic grafts. These include donor tissue and safe synthetic materials, like silicone.

Dermal fillers

Dermal fillers can correct mild cases of saddle nose. Some people call this nonsurgical rhinoplasty. Results are temporary, though — and you’ll need treatments every six to 12 months to maintain them.

Dermal fillers can’t improve breathing issues that arise from saddle nose deformity. You’ll need rhinoplasty for that.

How long does it take to recover after saddle nose treatment?

Most people feel better within a few weeks after rhinoplasty, but the recovery timeline varies for everyone. Your nose will continue to heal over the course of a year or sometimes more.

Dermal filler treatments typically don’t require any downtime.

When should I see my healthcare provider?

Schedule a visit with a provider at the first sign of saddle nose. The sooner you get treatment, the more predictable your results will likely be.

What can I expect if I have saddle nose?

Most people with saddle nose deformity can correct the issue with rhinoplasty. In those cases where saddle nose is a complication of rhinoplasty for another condition, you may need a second surgery. To avoid issues like this, it’s important to choose a board-certified facial plastic surgeon or otolaryngologist (ENT).