Saddle nose deformity is one of the more significant complications that can follow rhinoplasty, though it can also result from trauma, infection, or certain inflammatory conditions. It describes a depression or collapse in the middle portion of the nasal bridge — the nose takes on a sunken, concave appearance that can affect both how the nose looks and how well it functions.
Dr Scott J Turner is a Fellow of the Royal Australasian College of Surgeons (FRACS) with specific experience in complex rhinoplasty, including saddle nose reconstruction. He consults at his Sydney clinics in Bondi Junction and Manly, with surgery performed at Bondi Junction Private Hospital and Delmar Private Hospital, Dee Why.
What Is Saddle Nose Deformity?
A saddle nose refers to a depression or loss of height in the middle section of the nasal bridge. The structure of the nose relies on a framework of bone and cartilage for its shape and support. When that support is damaged or removed — through surgery, injury, disease, or structural collapse — the bridge can sink inward, creating the characteristic concave profile the term describes.
The degree of deformity varies considerably. Some patients have a subtle indentation that is most apparent in profile. Others have a more pronounced collapse that is visible from the front and significantly affects nasal breathing.
What Causes Saddle Nose Deformity?
Previous rhinoplasty. Over-resection of cartilage during rhinoplasty — particularly the septal cartilage that provides structural support to the middle third of the nose — can lead to gradual collapse of the nasal bridge over time. This is one of the more preventable causes, and is one reason why the preservation approach to rhinoplasty has become more widely adopted. Saddle nose deformity following rhinoplasty typically requires revision rhinoplasty with structural cartilage grafting to correct.
Trauma. Nasal fractures and blunt force injuries can damage the septal cartilage and bony framework directly. Where trauma is not treated promptly, or where a septal haematoma (blood pooling between the layers of the septum) is not drained, structural collapse can develop over time.
Inflammatory conditions. Granulomatosis with polyangiitis (formerly Wegener’s granulomatosis), relapsing polychondritis, sarcoidosis, and lupus can progressively erode nasal cartilage through inflammatory and autoimmune processes. These conditions require management by a rheumatologist alongside any surgical planning.
Infection. Severe nasal infections, including untreated septal abscess or cocaine-related damage to the nasal septum, can destroy the cartilaginous support of the bridge.
Congenital. Saddle nose deformity can be present from birth due to congenital malformations of the nasal cartilage or connective tissue disorders.
Symptoms
The presenting symptoms of saddle nose deformity depend on the severity of the structural collapse and whether functional problems are also present.
Appearance. The most noticeable sign is the sunken or scooped profile of the nasal bridge, which may be subtle or pronounced. The nose may also appear shortened, with an upturned tip, where the bridge collapse has altered the nasal length and tip position.
Breathing difficulty. Structural collapse of the nasal bridge frequently involves the nasal valves — the narrowest functional points of the nasal airway. Collapse or compromise of the internal nasal valve causes significant nasal obstruction and breathing restriction.
Nasal congestion. Chronic congestion or a persistent feeling of blockage may develop as the structural support of the airway is compromised.
Surgical Correction
Saddle nose correction typically requires structural reconstruction with rib cartilage grafts, which falls within the broader framework of revision rhinoplasty Sydney where the original blueprint has been altered. Dr Turner’s preference is autologous cartilage — the patient’s own tissue — rather than synthetic implants. Synthetic nasal implants carry higher long-term risks of infection, extrusion, and inflammatory reactions compared to autologous grafts, and are not used in Dr Turner’s practice for nasal reconstruction.
For minor deformities. Where the structural collapse is limited, subtle adjustments to the nasal dorsum may be sufficient. This may involve reshaping and reinforcing the upper lateral cartilages, adding an onlay fascial graft to smooth the bridge contour, or placing a modest cartilage graft to restore height without extensive reconstruction.
For moderate deformities. Cartilage grafting is required to rebuild the structural framework. Spreader grafts, septal extension grafts, and batten grafts are used depending on where the collapse has occurred and what the anatomy requires. Cartilage is harvested from the septum where available, or from the ear where septal cartilage is depleted or insufficient.
For significant deformities. More extensive reconstruction is required. Where the deformity involves significant structural loss, rib cartilage provides the volume and structural strength needed to rebuild the nasal bridge. Diced cartilage in fascia (small cartilage fragments wrapped in a tissue graft) may be used to restore dorsal height and contour. The operating time for complex reconstruction is typically three to four hours.
Saddle nose deformity often coexists with tip support compromise, particularly where significant cartilage was removed at primary surgery. The tip-specific revision techniques are covered in detail at tip revision rhinoplasty.
Can Saddle Nose Be Treated Without Surgery?
Dermal fillers can be used to add volume to a depressed nasal bridge and improve the appearance of mild saddle nose deformity. This is a temporary solution — results typically last several months before repeat treatment is needed. Filler does not address structural collapse or breathing problems and is not appropriate for moderate to severe deformities.
For patients with mild cosmetic concerns only and no functional impact, non-surgical treatment may be worth discussing at consultation. Where functional problems are present or the deformity is more than mild, surgery is the only effective long-term option.
Recovery
Recovery from saddle nose rhinoplasty follows the standard rhinoplasty timeline, though it may be more involved for complex reconstructions involving rib cartilage.
An external nasal splint is worn for approximately one week. Visible bruising and swelling are expected for two to three weeks. For rib cartilage harvest cases, there will be an additional incision site on the chest wall, which has its own recovery considerations.
The final cosmetic result, with all swelling resolved, is seen at 12 months. Where rib cartilage was used, the chest donor site typically heals with minimal visible scarring. Most patients return to desk-based work within one to two weeks.
For a week-by-week breakdown of rhinoplasty recovery, see the rhinoplasty recovery guide.
Medicare and Cost
Where saddle nose rhinoplasty addresses a documented functional problem — nasal valve collapse causing meaningful breathing obstruction — the functional component may attract a Medicare rebate under the relevant item numbers. A GP referral is required, and the functional need must be documented with clinical evidence.
The cosmetic component is not covered by Medicare regardless of the degree of deformity.
For full pricing details, see the rhinoplasty cost guide.
AHPRA Regulatory Requirements
Under AHPRA cosmetic surgery guidelines (effective 1 July 2023), the following apply before saddle nose rhinoplasty can proceed:
- A referral from your GP or a specialist physician
- A minimum of two consultations with Dr Turner before surgery is booked
- A psychological evaluation to confirm suitability
- A mandatory cooling-off period before formal consent is given
Frequently Asked Questions
What is saddle nose deformity?
Saddle nose deformity is a condition where the middle section of the nasal bridge loses structural support and collapses inward, creating a sunken or concave profile. It can be caused by previous rhinoplasty where too much cartilage was removed, nasal trauma, certain inflammatory or autoimmune conditions such as granulomatosis with polyangiitis, infection, or congenital malformation. It can affect both the appearance of the nose and nasal breathing function.
How is saddle nose deformity corrected?
Surgical correction involves rebuilding the nasal bridge using cartilage grafts. For minor deformities, septal cartilage reshaping or modest onlay grafts may be sufficient. For moderate deformities, spreader and extension grafts using septal or ear cartilage are used. For significant deformities, rib cartilage provides the structural volume needed to reconstruct the bridge. Dr Turner does not use synthetic implants for nasal reconstruction due to higher long-term risks of infection, extrusion, and inflammatory complications.
Can rhinoplasty cause saddle nose deformity?
Yes. Over-resection of cartilage during rhinoplasty, particularly the septal cartilage supporting the middle third of the nose, can lead to structural collapse over time. This is one of the more significant risks of aggressive rhinoplasty and is a primary reason why the preservation approach has become standard practice. Saddle nose deformity from previous rhinoplasty typically requires revision surgery with structural grafting to correct.
What cartilage is used to fix a saddle nose?
The choice depends on severity and available material. Septal cartilage is preferred where available and sufficient. Ear cartilage is used for moderate cases where septal cartilage is depleted. Rib cartilage is used for significant deformities requiring substantial structural reconstruction. All are autologous — the patient’s own tissue — which provides better long-term biocompatibility than synthetic alternatives.
Is saddle nose rhinoplasty covered by Medicare?
Where the procedure addresses a documented functional problem such as nasal valve collapse causing breathing obstruction, the functional component may attract a Medicare rebate under the relevant item numbers. A GP referral is required and clinical documentation must support the functional indication. The cosmetic component is not covered. See the Medicare rhinoplasty guide for full details.
Consult with Dr Scott J Turner
Dr Turner consults for saddle nose rhinoplasty in Sydney at Bondi Junction and Manly. He also sees patients in Brisbane, Canberra, Newcastle, and the Gold Coast. Surgery is performed in Sydney at Bondi Junction Private Hospital and Delmar Private Hospital, Dee Why.
Contact the practice to arrange a consultation, or read more about Dr Turner’s background and training.
