What is Saddle Nose?

Saddle Nose deformity, also known as a collapsed nose bridge, is characterised by a sunken or concave appearance to the bridge of the nose, giving the upper nose the shape of a saddle when viewed in profile. As well as causing cosmetic concerns, this dip in the upper nose can also lead to functional issues such as breathing difficulties, snoring, or sleep apnoea due to the altered shape of the airways running through the nose. In addition to being uncomfortable, breathing concerns can impact overall health by reducing sleep quality and making exercise challenging.

Saddle deformity can be effectively addressed through Rhinoplasty or Septorhinoplasty surgery, depending on the nature and severity of your concerns. Cadogan Clinic has brought together a team of the most experienced Rhinoplasty surgeons in the UK who focus on producing high-quality, patient-focused results to address cosmetic and functional nose concerns. 

What Causes a Saddle Nose Deformity?

Nose saddling is typically caused by the cartilage in the upper nose collapsing due to damage or loss of structural support – although this can occur for several reasons. When the internal support structures of the nose are damaged, the length of the nasal bridge falls inwards, creating a depression. The severity of Saddle Nose deformity can vary dramatically. In some cases, it will be a slight indent, whereas for other patients, it can significantly impact the overall appearance of the face. Saddle nose causes include:

Complications following nose surgery: Previous nose procedures that have involved significant surgery on the septum (the cartilage separating the nostrils), such as Septorhinoplasty or Septoplasty, can cause Saddle Deformity. It occurs if adequate support has not been given to the septum during the surgery or too much cartilage has been removed, leading to a gradual nasal bridge collapse. This complication is rare, and your surgeon will discuss this with you if they feel your procedure has a risk of leading to a Saddle Nose.

Injury or trauma to the nose: Injury is the most common cause of Saddle Nose deformity. Impact to the front of the nose can cause damage to the internal cartilage and septum, leading to the bridge of the nose collapsing. Complications arising from a nose injury, such as a septal haematoma (blood collecting in the septum) or the original injury not being appropriately managed, can also worsen the development of Saddle Nose.

Medical conditions: Medical conditions such as granulomatosis with polyangiitis and systemic lupus erythematosus can lead to the breakdown of the nasal cartilage due to ongoing inflammation. As the internal nasal structures deteriorate, the nose collapses inwards, affecting its appearance and also leading to functional concerns such as severe breathing difficulties.

Substance use disorder (SUD): Inhaling drugs through the nose over long periods of time can damage the internal nasal structures, leading to the breakdown of the cartilage. As the septum and other cartilage become weakened, a collapsed nasal bridge can develop over time.

For patients whose Saddle deformity is caused by substance use, which they have now given up, the remaining nasal bridge collapse may act as an unwanted reminder of a negative period in their lives. The visual signs may also cause self-consciousness and make them worry that people will judge them for previous actions. 

Signs of Saddle Nose

Depending on saddle nose causes, it can develop gradually over time or appear suddenly. A blunt force injury can create a collapsed nose bridge very suddenly, whereas inflammation or medical conditions will result in a slower development. Early signs of Saddle Nose may not be noticeable.

Visible signs of Saddle Nose deformity include:

• A flat or concave appearance to the bridge of the nose
• Turned-up nasal tip
• A horizontal crease on the lower portion of the nose
• Nose bleeds

There are also signs of a collapsed nasal bridge which may not be visible:

• Nasal septum perforation – a hole in the cartilage separating the nostrils
• Breathing difficulties
• Pain or discomfort

If you are concerned about any of these symptoms, it is important to speak with a specialist surgeon who can diagnose a collapsed nose bridge and advise on the best treatment plan to address your concerns. 

Stages of Saddle Nose Deformity

Depending on the severity of the cartilage breakdown within the nose, nose saddling can be categorised into different stages:

Minimal Saddle Nose: A small depression in the nose’s dorsum (the nasal bridge) can be seen, but may not be obvious from all angles.

Moderate Saddle Nose: A larger depression is visible in the nasal bridge, and the nose looks flattened from all angles. At this stage, the tip of the nose may also partially turn upwards.

Major Saddle Nose: The lack of support and cartilage in the nose is obvious from the outside and the dorsum has visibly sunken inwards. The tip of the nose is turned up significantly.

Your surgeon will take the severity of your Saddle Nose Deformity into account when deciding on the right treatments to address your concerns. 

Treatments for Saddle Nose Deformity

Depending on the severity of your nose saddling, the cause and any other associated concerns, there are several treatment options to address Saddle Nose deformity. 

Surgical Saddle Nose Treatments

Most solutions for a collapsed nose bridge are surgical. These are often the most effective options as they are permanent and don’t require further intervention or maintenance. 

Non-Surgical Saddle Nose Treatments

For some patients, non-surgical options may be an effective treatment. 

Is Saddle Nose Treatment Permanent?

Whether the results of Saddle Nose treatment are permanent will depend on the cause of the concerns and the nature of the treatment.

Surgical Saddle Nose treatments are permanent as long as the causes of the Saddle Nose deformity have been addressed. In cases where a collapsed nose bridge has been caused by ongoing substance use, your surgeon will ask you to abstain from any drugs for at least 12 months ahead of surgery and will ask you not to start again following surgery to maintain your results. For patients suffering from chronic inflammation caused by a medical condition, your surgeon will have recommended any treatments to manage this ahead of surgery. However, if surgery is needed to improve breathing and inflammation cannot be managed completely, further surgery may be required. Your surgeon will discuss how long you can expect your results to last during your consultation process.

Non-Surgical Saddle Nose treatment isn’t permanent and will require follow-up appointments for maintenance. Non-Surgical Rhinoplasty usually requires follow-up treatments every 6-12 months, and it is important to factor this into your considerations about Saddle Nose treatment. 

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