The back fell
In profile, a depression is visible on the back.
CONDITION / CARRY
Saddle-shaped nose.
Saddle nose is a depression of the bridge of the nose when the support of the septum is lost. Most often, it occurs after an injury or surgery on the septum; it is corrected by reconstructing the support, most often with its the patient's own cartilage.
CONCEPTUAL VISUALIZATION- what is it
- The collapse of the bridge of the nose due to the loss of support - cartilage of the septum or bones.
- The most common reasons
- Nasal trauma and previous operations on the septum.
- How to fix
- They restore support with their the patient's own cartilage - from the septum, ear or rib.
- Who treats
- A surgeon who performs reconstructive operations on the nose.
01 / WHAT IS ITWhat is a
What is a
saddle nose.
The back of the nose is held by a cartilaginous septum - a kind of "L-shaped beam". When it is destroyed or weakened, the back above it sags, and the nose in profile resembles a saddle. The tip often becomes pointed, and the middle part becomes wider.
There is minimal subsidence, visible only in profile, moderate and pronounced when most of the support is lost. The degree depends on which cartilage and how the back is restored.
A saddle-shaped nose is not only a matter of appearance: without support, the nasal passages narrow and it becomes more difficult to breathe.
This is general information. The doctor will tell you what will suit you after the examination.
02 / SIGNSHow a
How a
saddle nose manifests itself.
Changes may appear immediately after an injury or gradually — months after an operation or illness.
Sharp tip
The tip rises and shortens.
Wide back
The middle part of the nose becomes wider and flatter, the nose seems shorter.
Breathing
The nose breathes worse than before.
Distortion of the septumA hole in the partition
It can be combined with perforation of the septum - especially in granulomatosis with polyangiitis or after the use of cocaine.
Perforation of the septum03 / REASONSWhy does the
Why does the
back sink.
The most common causes are nasal trauma and previous operations on the septum.
Injury
A fracture of the nose and septum destroys the support of the back.
Nose after injuryPrevious operations
If too much cartilage is removed during surgery or its attachment is broken, the back will sag over time.
Nose after rhinoplastySeptal abscess
In a review of 90 cases of septal abscess among patients with complications, saddle nose was the most frequent (70.59%).
Diseases
Granulomatosis with polyangiitis can destroy the septum: among patients with perforation of the septum, saddle nose occurred much more often than for other reasons.
Cocaine
Destroys the tissues of the midline of the nose: in a series of 40 patients, 22.5% had a saddle-shaped nose.
04 / SEEK MEDICAL ADVICE
When to seek medical advice?
An old saddle nose does not require emergency care. But if the back began to sag after a recent injury, don't wait: the cause may be a hematoma or abscess of the septum.
103 immediately if:
- bleeding does not stop after 15 minutes of pressing;
- after a fresh injury - loss of consciousness, severe headache, vomiting, double vision or clear liquid from the nose;
- high fever with swelling of the eyelids, severe headache or visual disturbances.
To the doctor on the same day, if:
After the injury, severe pain, swelling inside the nose or congestion, especially with temperature, appeared - this is how a hematoma or abscess of the septum appears. If your back has sunk in for a long time, make an appointment for a scheduled consultation.
05 / DIAGNOSTICSHow to determine
How to determine
what to restore.
- Conversation
Injuries, operations, illnesses; if a systemic disease is suspected, appropriate tests.
- Examination and endoscopy
Evaluation of the septum, back, tip and valves of the nose.
- Degree of subsidence
From minimal, visible only in profile, to pronounced, when most of the support is lost, the choice of cartilage and the scope of the operation depend on it.
- CT scan if necessary
Evaluation of the bones and the remnant cartilage of the septum.
06 / TREATMENTHow to fix
How to fix
saddle nose.
The main thing is to restore support, and not just "put on" the back. The authors of the 2018 review emphasize reconstruction of the septum in most cases.
01
What restores resistance
- Cartilage of the ear
- In case of moderate subsidence, ear cartilage was used in a series of 25 patients.
- Costal cartilage
- With pronounced depression. In a meta-analysis of 20 studies (1,648 patients), cartilage was deformed in 3.05% of cases, reoperation was required in 2.25%; in another meta-analysis (491 patients), reoperations were 14.07%.
- New partition
- If necessary, the septum is completely restored - with extended spacer grafts or a new "L-beam".
02
The result
- Appearance
- In a study of 91 patients, 71 patients had an excellent or good aesthetic result after correction, reoperation was required in 9%.
- With systemic diseases
- In granulomatosis with polyangiitis, reconstruction is safe if the disease is under control, but repeated operations are required more often.
07 / AT THE VALIKHNOVSKY CLINIC
How do we
How do we
treat it.
A saddle-shaped nose is corrected in the "New Nose" direction at Dr. Valikhnovsky's Institute of Surgery, along with nose reconstruction after injuries and failed operations.
DIRECTION TO THE CLINIC
A new nose
Shape, support and breathing of the nose: septum, concha, sinuses, consequences of injuries, failed operations and removal of tumors.
Go to direction
What do we do in this condition
- Cartilage grafts — the patient's own cartilage from the septum, ear or rib to restore the back.
- Reconstruction of the nasal septum — restoration of the main support of the nose.
- PDS plates — absorbable support for partition fragments.
- Secondary and tertiary rhinoplasty — if the subsidence is a consequence of previous operations.
Rostislav Valikhnovsky
Plastic surgeon, candidate of medical sciences, founder of Dr. Valikhnovsky Institute of Surgery.
Publications by topic
How is the treatment in us
- Photo onlineSend a photo of the nose and describe what preceded the collapse.
- ConsultationExamination, endoscopy, photo; if necessary — CT scan and tests.
- PlanHow to restore support and where to get cartilage.
- OperationReconstruction of the septum and back with the patient's own cartilage.
- RecoveryThe first weeks — tire and swelling; the final form is formed gradually, in about a year.
08 / QUESTIONS AND ANSWERSFrequently asked
Frequently asked
questions.
Short answers. What is right for you, the doctor will tell you during the consultation.
Can a saddle nose be corrected without surgery?
The support of the nose cannot be restored without surgery. Methods that only fill the cavity do not restore support and do not improve breathing.
Where is the cartilage taken from?
First, from the partition, if there is any left; with moderate depression - from the ear, with pronounced - from the rib. Own cartilage.
Can costal cartilage deform?
Yes, this is the most common complication: in a meta-analysis of 1648 patients — 3.05%. Reoperation was required in 2.25%, and in another meta-analysis (491 patients) in 14.07%.
Will breathing improve?
Restoring the support aims to widen the nasal passages. Therefore, the operation is planned taking into account both the form and breathing.
Is it possible to operate on granulomatosis with polyangiitis?
Yes, if the disease is under control. Reconstruction is safe, but repeat operations are needed more often.
What does the choice of cartilage depend on?
From the degree of subsidence. In one series of 25 patients, minimal subsidence was corrected with own septum, moderate - with ear cartilage, pronounced - with costal cartilage; repeated operations were not required.
Will there be a scar if the costal cartilage is taken?
Yes, a small scar on the chest. In a meta-analysis of 491 patients, 5.45% had a hypertrophic scar at the injection site, no pneumothorax.
How long does recovery take?
The first weeks — swelling and swelling; the final shape of the nose is formed gradually, in about a year.
Sources
11 sources · reviews, guidelines and studiesShowCollapse
- Refinements in Saddle Nose ReconstructionFacial Plastic Surgery, 2018doi:10.1055/s-0038-1660824 ↗
- Treatment outcomes of saddle nose correctionJAMA Facial Plastic Surgery, 2013doi:10.1001/jamafacial.2013.84 ↗
- Saddle nose: classification and therapeutic managementEuropean Annals of Otorhinolaryngology, Head and Neck Diseases, 2014doi:10.1016/j.anorl.2013.01.006 ↗
- Complications Associated with Autologous Costal Cartilage Used in Rhinoplasty: An Updated Meta-AnalysisAesthetic Plastic Surgery, 2023doi:10.1007/s00266-022-03075-3 ↗
- Complications associated with autologous rib cartilage use in rhinoplasty: a meta-analysisJAMA Facial Plastic Surgery, 2015doi:10.1001/jamafacial.2014.914 ↗
- Nasal Septal Abscesses: A Systematic ReviewJournal of Craniofacial Surgery, 2025doi:10.1097/SCS.0000000000011029 ↗
- Reconstructive Techniques for the Saddle Nose Deformity in Granulomatosis With Polyangiitis: A Systematic ReviewJAMA Otolaryngology–Head & Neck Surgery, 2017doi:10.1001/jamaoto.2016.3484 ↗
- Saddle nose deformity and septal perforation in granulomatosis with polyangiitisClinical Otolaryngology, 2018doi:10.1111/coa.12977 ↗
- Saddle Nose in Granulomatosis With Polyangiitis (GPA) vs. Non-GPA Patients With Septal PerforationsLaryngoscope Investigative Otolaryngology, 2025doi:10.1002/lio2.70217 ↗
- The role of ANCA in the management of cocaine-induced midline destructive lesions or ENT pseudo-granulomatosis with polyangiitis: a London multicentre case seriesLaryngoscope, 2024doi:10.1002/lary.31219 ↗
- Features of surgical tactics in the reconstruction of the nasal dorsum (Features of surgical tactics in the reconstruction of the nasal dorsum)Clinical Anatomy and Operative Surgery, 2025doi:10.24061/1727-0847.24.3.2025.38 ↗
The figures on the page are from these sources.
The bridge of the nose
falls in?
Send a photo and describe what preceded the collapse. The doctor will tell you how to restore support and with what.