Saddle Nose

What is a saddle nose?

Saddle nose — or saddle nose deformity — refers to the collapse of your nasal bridge (the middle part of your nose) and loss of nasal height. The condition gets its name from the sunken-in, saddle-like appearance.

Saddle nose deformity changes the appearance of your nose. But it can also cause breathing issues that may interfere with everyday life. Left untreated, saddle nose can worsen over time.

Other names for saddle nose deformity include boxer’s nose and pug nose.

How do I know if I have saddle nose?

The telltale sign of saddle nose is a dip in your nose bridge. This concavity may become more obvious over time.

Some people may develop saddle nose almost immediately, which often happens in cases of trauma. Others may develop signs gradually.

Other saddle nose symptoms may include:

• Nasal pain or discomfort.
• Nosebleeds (epistaxis).
• Chronic crusting around your nose.
• Turned-up nasal tip.
• Breathing issues.
• Horizontal crease on the lower portion of your nose.
• Nasal septum perforation (when there’s a hole in the cartilage that separates your nostrils).

What causes saddle nose?

Anything that damages your nasal septum can lead to saddle nose deformity. This is because your septum provides structural support for your nose. Some people may be born with saddle nose.

Specific saddle nose causes include:

• Trauma. A damaged or fractured nose can lead to a breakdown of your septum (the piece of cartilage that separates your nostrils). This is the most common cause of saddle nose deformity.
• Prior nasal surgeries. Septoplasty (surgery to correct a deviated septum) may result in saddle nose deformity. This is particularly true with severe cases of deviated septum.
• Septal hematoma. This refers to a collection of blood in your septum (from trauma or surgery). It can interfere with blood flow to your septum, leading to saddle nose.
• Septal abscess. This happens when infection (pus) collects in your septum. This can also hinder blood flow and cause saddling.
• Vascular and autoimmune diseases. These conditions can cause inflammation in your septum, which can lead to decreased blood flow. As these diseases worsen, your septum may weaken and lead to a sagging nasal bridge.
• Infections. Certain bacterial infections, such as syphilis and Hansen’s disease (leprosy), can affect your bones and cartilage. This may mean your nose doesn’t get enough blood, causing sagging and saddling. Syphilitic saddle nose may be an acquired symptom of syphilis — or you may be born with it.
• Substance use disorder (SUD). Snorting (insufflating) cocaine, methamphetamines, crushed opioid pills or other drugs can damage your nasal structures, leading to saddle nose deformity.

What are the complications of saddle nose?

Saddle nose can cause a number of breathing complications, including:

• Chronic sinus issues.
• Snoring.
• Obstructive sleep apnea.
• A whistling sound when breathing through your nose.

How is saddle nose diagnosed?

A healthcare provider can diagnose saddle nose during a physical examination. They’ll ask about your symptoms in detail and discuss your cosmetic goals. They’ll also ask about any breathing issues you’re having. They may take photographs of your nose to document the severity of your condition.

What are the stages of saddle nose?

Healthcare providers categorize saddle nose deformities into three stages, according to how much structural support you’ve lost:

• Minimal saddle nose: There’s a small depression in your dorsum (the bridge of your nose).
• Moderate saddle nose: There’s a larger depression 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 bony support and cartilage, causing your dorsum to sink in. The tip of your nose turns upward.

How do you fix a saddle nose?

Surgery is the most common treatment for saddle nose deformity. However, 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 a combination of bone, cartilage and tissue grafts to rebuild your nose and restore your breathing.

Dermal fillers

In mild cases, when appearance is the main concern, dermal fillers can correct saddle nose. Some people call this nonsurgical rhinoplasty. Results are temporary, though — and you’ll need treatments every six 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?

In general, most people feel better in four to six weeks after rhinoplasty. However, your nose will continue to heal over the course of a year. The recovery timeline varies for everyone.

People who receive dermal fillers typically don’t require any downtime.

Can I prevent saddle nose?

You can’t always prevent saddle nose deformity. In some cases, it’s a symptom of unavoidable trauma. It may also be congenital in some cases (meaning you’re born with it).

How can I lower my risk for saddle nose?

To reduce your risk of saddle nose deformity:

• Treat nose fractures as soon as possible.
• Practice safe sex to reduce your risk of syphilis and syphilitic saddle nose.
• Wear a nose guard if you play contact sports.
• Get treated for vascular and autoimmune diseases.
• Don’t snort cocaine, methamphetamines or crushed opioid pills.

What can I expect if I have saddle nose?

Most people with saddle nose deformity can correct the issue with rhinoplasty. However, success of treatment depends on several factors, including the severity of your condition. Talk with your healthcare provider to find out what to expect in your situation.

Saddle nose after rhinoplasty

Saddle nose deformity can also occur after rhinoplasty for other conditions. This may happen if surgeons remove too much cartilage during the procedure. In these cases, a second rhinoplasty may be necessary. To avoid complications like this, choose a board-certified facial plastic surgeon or otolaryngologist (ENT).

When should I see my healthcare provider?

You should schedule a visit with a healthcare provider at the first sign of saddle nose. The sooner you undergo treatment, the more predictable your results.

What questions should I ask my healthcare provider?

If you have saddle nose deformity, here are some questions to ask your healthcare provider:

• How advanced is my condition?
• What are my treatment options?
• How long will recovery take?
• What results can I expect?

Is saddle nose serious?

Saddle nose deformity may be a symptom of more serious autoimmune disorders, including relapsing polychondritis and granulomatosis with polyangiitis (formerly called Wegener’s). For this reason, you should see a healthcare provider if you suspect saddle nose.

A note from Cleveland Clinic

Saddle nose deformity refers to a sunken-in nasal bridge and a loss of nasal height. It happens when the cartilage that gives your nose shape breaks down. Rhinoplasty is the most common treatment for saddle nose, and most people achieve desired results with this approach. When correcting saddle nose, prompt treatment is key. If you notice sagging in your nasal bridge that wasn’t there before, schedule an appointment with a healthcare provider.