Saddle Nose Deformity

Address the “Scooped Out” Look in the New York Area

When referring to a saddle nose or saddle nose deformity, New York-area rhinoplasty and nose specialists are typically referring to a nose that looks a little scooped out on the side. If one can picture a horse’s saddle, this shape and configuration is consistent with the concave aspect of the saddle facing upward.

There are many causes of a saddle nose deformity, including some disease conditions that can affect the nasal septum (i.e. Wagner’s Granulomotosis, whereby the major support mechanism of the nose or the nasal septum becomes afflicted with the condition resulting in loss of support in the midsection of the nose so that there is some saddling, which results in a saddle nose deformity).

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To request a consultation for addressing a saddle nose deformity in the New York area, contact the Williams Center for Plastic Surgery online or by phone at 1-800-742-2797.

Another common condition that can result in a saddle nose deformity is a septic perforation, defined as a hole in the nasal septum, which is basically a partition between the right and left side of the nose. If the perforation or hole is large enough, it can affect the support of the mid-aspect of the nose, resulting in saddling or collapse in the mid-aspect of the nose.

There are many causes of a septic perforation, including but not limited to trauma and other factors far beyond the purpose of this discussion. Suffice it to say, septic perforation is another known cause of saddle nose deformity.

Trauma to the nose and especially trauma to the nasal septum can result in a compromise in the blood supply of the nasal septum by various mechanisms. This can result in a loss of support and weakening of the nasal septum, whereby there is settling in the mid-aspect of the nose resulting in a saddle.

Finally, and unfortunately, surgery performed poorly can also result in a scooped out or saddle nose deformity. When surgery is performed without good attention to detail and leaving a nose strong and supported, it can result in the saddle nose deformity.

Fixing the saddle nose deformity first starts by receiving the opinion of a very experienced rhinoplasty specialist. Saddle nose deformities are complex and are often associated with other symptoms, including difficulty breathing, chronic bloody noses, and nasal collapse. An experienced plastic surgeon should be able to put together a plan whereby to revise or rebuild the nose. There are many ways that a saddle nose deformity can be repaired by an experienced surgeon. Almost all approaches require harvesting some additional support or cartilage to rebuild the nose. The ideal situation is when there is sufficient septal cartilage remaining in the nose for the surgeon to use to rebuild the saddle. Unfortunately, in many circumstances, this is not the case, so ear cartilage can be used by the surgeon to rebuild the nose—though ear cartilage is not sufficient in many circumstances because it does not provide enough structure or support, in which case rib cartilage is the preferred option. An experienced, revision rhinoplasty specialist often harvests rib cartilage from an inconspicuous area to help rebuild the nose.

Saddle Nose Deformity FAQs


Where Are the Incisions in Surgery to Correct Saddle Nose Deformity?

The incisions for saddle nose rhinoplasty depend on whether the open approach or the closed approach is performed. The closed approach, often referred to as endonasal or scarless rhinoplasty, has some desirable advantages, including a lack of incisions on the exterior of the nose, less discomfort, shorter healing time, and more certain outcomes.

While some surgeons still prefer the open approach to saddle nose rhinoplasty, believing it offers a better vantage point for a more precisely performed surgery, Dr. Williams recognizes that the complex nature of the endonasal approach demands commitment. He took 10 years to develop the necessary skills. Starting with the open approach in the early years of his practice gave him the experience needed to now almost exclusively perform endonasal surgery.

The saddle nose rhinoplasty is further discussed in the doctor’s Famous Fireside Chats series titled The Great Debate: Open vs. Closed Rhinoplasty.


Do You Pack the Nose After Surgery for Saddle Nose Deformity?

After saddle nose surgery, Dr. Williams sees no need to heavily pack the nose, which can be very uncomfortable for the patient. Using the endonasal or scarless technique, Dr. Williams finds that light packing in the nostrils is all that is required if the procedure is performed properly. If the nose is not in the exact desired position after the surgery, heavy packing will not help that. The lighter packing is removed a day or so after the operation.

In about one week, when the outer splint is removed, Dr. Williams suggests the patient avoid any situations that involve activity that could bump the nose.

In Dr. Williams’ Famous Fireside Chats video, he shows you in detail how he packs and dresses the nose in saddle nose surgery procedures.


Will Surgery for Saddle Nose Deformity Fix Breathing Problems?

Many patients with saddle nose deformity also suffer from a deviated nasal septum, narrowing of nasal valves, or a twisted or crooked nose, any of which can cause breathing problems.

Patients considering surgery to correct saddle nose deformity can have the surgeon evaluate their situation to see what function and cosmetic aspects can be addressed during surgery.

Dr. Williams’ Famous Fireside Chats answer these and other concerns regarding fixing breathing during a surgery for a saddle nose deformity.


The Cost of Surgery for Saddle Nose Deformity

When pricing saddle nose surgery, several key factors are involved. If this is a first-time (primary) surgery for saddle nose deformity, costs will be lower than for a second or third procedure, considered a revision. Follow-up surgeries are typically more difficult than primary surgeries, since they take longer and require a very skilled surgeon.

Also, a surgeon’s experience with surgery for saddle nose deformity is a significant cost factor, as the doctor’s years of performing the procedure offer patients a measure of extra assurance that they are in good hands when it comes to their saddle nose deformity.

Naturally, where the surgeon’s practice is located can also effect the cost of surgery, given that the cost of living and doing business varies considerably from location to location.

Depending on several other factors, like OR fees and anesthesia, fees for surgery to correct saddle nose deformity can range from $7,000 to $14,000. Refer to Dr. Williams’ Famous Fireside Chats for additional information on costs of surgery for saddle nose deformity and other conditions.


Contact Lenses or Glasses Following Surgery for Saddle Nose Deformity

Since most surgeons place a splint or cast on the outside of the nose after surgery for saddle nose deformity, wearing glasses afterward can be difficult. Dr. Williams shares a simple trick with his patients: Take a bit of tape and put it on the middle of the glasses, then hang them from the forehead.

For patients wearing contact lens, Dr. Williams advises them to wait until the splint is removed, around one week after surgery, before using them again.


How is Computerized Imaging Used in Surgery for Saddle Nose Deformity?

In saddle nose surgery, pictures of the patient’s nose are taken with a digital camera and uploaded to a computer. This allows a surgeon to modify the photos or images to show the patient what he sees and how he would address their concerns. It also gives the patient a visual—though not exact—idea of the potential or ideal outcome of surgery.

For nearly 25 years, Dr. Williams has relied on computerized imaging in saddle nose surgery as a useful communication tool.

In his YouTube series, Fireside Chats on Rhinoplasty, and his book, Rhinoplasty: Everything You Need to Know about Fixing and Reshaping Your Nose, Dr. Williams answers the most frequently asked questions regarding a saddle nose deformity.


Complications and Risks of Saddle Nose Surgery

Experienced and reputable surgeons aim to fully discuss complications with a patient prior to surgery for saddle nose deformity.

While there is always a chance of some bleeding or infection in any surgical procedure, complications are quite uncommon in surgery for saddle nose deformity. While not a complication, revision or touch-up surgery after a saddle nose surgery may be required. The numbers show that five to 10 percent of saddle nose surgery patients will opt for a touch-up procedure.

This percentage is greatly reduced when the surgery for saddle nose deformity is carried out by a highly competent rhinoplasty surgeon. Also, the need for a touch-up procedure after saddle nose surgery is relatively minor and can be done in the office. Even the most experienced and perfectionistic surgeon cannot guarantee a flawless outcome, as every surgery is different. The surgeon must be skilled and gifted, blending a deep understanding of the complicated nature of facial anatomy and customizing the surgery to achieve an ideal outcome.

When inadequate communication has occurred between a patient and surgeon, there is a chance that the patient’s expectations will not have been met. To avoid such disappointments, the surgeon and saddle nose deformity patient should sit down for a consultation that fully explores what the surgery can achieve, given the patient’s concerns.

More information on complications following surgery for saddle nose deformity is available on Dr. Williams’ Famous Fireside Chats.


Anesthesia in Surgery for Saddle Nose Deformity

Many saddle nose surgery patients prefer twilight or general anesthesia, as this allows them to be asleep during the procedure. Many surgeons also find this desirable. The anesthesia options in surgery addressing a saddle nose deformity consist of local and twilight or general anesthesia.

All anesthesia options are monitored and controlled by credentialed anesthesia providers and permit patients to return home after the surgery.

Saddle nose surgery is further explained in Dr. Williams’ Famous Fireside Chat on Anesthesia for Rhinoplasty.

If you’re considering a procedure to correct a saddle nose deformity and want to consult with an experienced New York-area facial plastic surgeon, call the Williams Center at 1-800-742-2797 today!

To request a consultation in the New York area, contact the Williams Center for Plastic Surgery online or by phone at 1-800-742-2797.

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