A saddle nose is a dip or scooped-out appearance in the middle of the nasal bridge, caused by loss of support from the septum or nasal bones. It most often follows injury, a septal haematoma or previous nasal surgery, but it can also be linked to some medical conditions. Mild dips can be camouflaged; more significant collapse is treated with reconstructive rhinoplasty using cartilage grafts to rebuild the bridge and support the tip.
What a saddle nose looks like
When the septum loses strength, the middle of the nose sinks, like the dip in a horse’s saddle. The appearance varies:
- Mild: a subtle scoop just above the tip, sometimes only visible in profile.
- Moderate: a clear depression of the cartilage part of the bridge, often with a tip that turns up and looks short.
- Severe: collapse of both bone and cartilage, a flattened, widened nose and often significant breathing difficulty.
Breathing problems are common because the collapse also narrows the nasal valves.
Common causes
- Trauma: a broken nose can fracture or buckle the septum.
- Septal haematoma: a collection of blood under the lining of the septum after injury, which, if not drained, can starve the cartilage of blood supply and lead to its loss.
- Previous surgery: removing too much septal cartilage during septoplasty, or over-reducing the bridge during rhinoplasty.
- Infection: a septal abscess can destroy cartilage.
- Substance use: repeated intranasal cocaine use can damage the blood supply of the septum and cause perforation and collapse.
- Medical conditions: some inflammatory and autoimmune conditions can affect the cartilage of the nose.
Why a medical check comes first
Where there is no clear history of injury or surgery, it is important to rule out an underlying medical cause before any cosmetic or reconstructive surgery. Your GP may arrange blood tests or referral to an appropriate specialist. Surgery is generally only considered once any active condition is well controlled, because ongoing inflammation can compromise healing and the long-term result. Anyone who has used intranasal drugs will be advised that surgery is only appropriate once use has stopped completely.
Non-surgical camouflage
A small, shallow dip may be softened with dermal filler to smooth the profile. This is a temporary camouflage, does not restore structural support or improve breathing, and the nose has a delicate blood supply, particularly after previous surgery or injury, so the risks of filler are higher. Many surgeons advise against filler in a nose that has already lost its blood supply or cartilage.
Reconstructive rhinoplasty
Repair aims to rebuild the framework of the nose. Cartilage grafts are shaped to restore the height of the bridge, reinforce or replace the lost part of the septum, open the nasal valves and support the tip. Cartilage may be taken from what remains of the septum, from the ear, or from a rib when larger amounts are needed. An open approach is usually used to allow precise placement. Mr Nassab will explain whether your case is suitable for his care or whether referral to a specialist reconstructive nasal service is more appropriate, particularly for severe or medically related collapse.
What can realistically be achieved
Reconstruction can improve the profile and breathing considerably, but noses that have lost support and blood supply are more complex to operate on. Scar tissue from previous surgery limits how much the skin can stretch over a rebuilt bridge. Some grafts can shift, warp or be partly reabsorbed over time, and more than one operation is sometimes needed. Setting realistic goals before surgery is essential.
Recovery and cost
Recovery is similar to other rhinoplasty but can take longer. A splint is worn for around a week, bruising usually settles over two to three weeks and swelling can persist for a year or more. If rib cartilage is used there will be a small chest scar and some discomfort there. Rhinoplasty costs from £8,950 but reconstructive cases are individually quoted at consultation; the £150 consultation fee is separate. Surgery is for adults aged 18 and over.
Frequently Asked Questions
Can a saddle nose get worse over time?
It can progress if the septum continues to weaken, particularly with an active medical cause, so early assessment is sensible.
Is saddle nose repair more complex than standard rhinoplasty?
Yes. It involves rebuilding support with grafts, often through an open approach, and may need rib cartilage.
Will repairing a saddle nose help my breathing?
Restoring septal support and opening the valves often improves breathing, although results vary between individuals.
Can filler fix a saddle nose?
Filler can camouflage a mild dip but does not restore support and carries higher risks in a nose that has been injured or operated on.
Is rib cartilage always needed?
No. Mild cases may be repaired with septal or ear cartilage. Rib cartilage is used when more support is required.
