Saddle Nose (Nasal Collapse): Causes and How It Is Repaired

A collapsed or "saddle" nose is one of the most recognisable nasal deformities: the bridge sinks between the top of the nose and the tip, giving a dented, boxer-like profile. It can follow an injury, a previous rhinoplasty that removed too much support, or certain medical conditions. Because both appearance and breathing suffer, repair is reconstructive as much as aesthetic. This article explains how to recognise nasal collapse, why it happens and how it is rebuilt.

Key takeaways

• Saddle nose means loss of support in the middle of the nose, creating a dip in the bridge.

• The main causes are trauma, over-reduction in a previous rhinoplasty, septal hematoma or infection, and some inflammatory diseases.

• Repair rebuilds the bridge and septum with cartilage grafts, often from the rib or ear.

• Breathing usually improves when structural support is restored.

What is a saddle nose?

The nose keeps its shape through a "roof" of nasal bones and cartilage supported by the septum in the middle. When the septum or the cartilage of the bridge loses height, the roof sinks. The result is a visible dip between the radix and the tip, often with a wide, flattened appearance, a short or upturned tip and reduced projection. Patients frequently have blocked breathing because the internal support has collapsed too.

What causes nasal collapse?

• Trauma: fractures, sports injuries and untreated septal hematoma (a blood collection that destroys septal cartilage).

• Previous surgery: over-resection of the hump or septum in an earlier rhinoplasty leaves too little support, and the bridge sinks months or years later.

• Infection or abscess of the septum.

• Medical conditions such as certain inflammatory or autoimmune diseases, and cocaine use, which erode the septum.

• Congenital weakness of the septal cartilage, which is rare.

How it is recognised

Signs include a depressed bridge, a widened and flattened middle third, loss of tip support, shortening of the nose with an upturned tip, retraction of the columella and nasal obstruction. A careful examination, often with endoscopy and sometimes imaging, defines how much support has been lost.

How saddle nose is repaired

The principle is simple: rebuild what is missing. Depending on severity, Prof. Dr. Suleyman Tas uses:

• Septal cartilage for mild cases, if enough remains.

• Ear cartilage for moderate dorsal augmentation.

• Rib cartilage for major reconstruction, carved into a dorsal graft and septal extension grafts that restore height, length and tip support.

The grafts rebuild the bridge line, re-support the septum and open the airway. The operation is more complex than a primary rhinoplasty and may be performed through an open approach when a large reconstruction is needed.

Recovery and results

Swelling lasts longer than after a primary rhinoplasty, and the final profile emerges over 12 months. Results are stable when strong grafts are used. Breathing typically improves markedly. Patients with a previous over-resected nose should wait at least a year after the last surgery before reconstruction.

Frequently asked questions

Can a saddle nose be treated without surgery?

Small dips can be camouflaged temporarily with filler, but this does not restore support or breathing and carries risks in operated noses. Surgery is the definitive treatment.

Does rib cartilage leave a scar?

A short scar in the chest fold, usually well hidden. Ear cartilage leaves a hidden scar behind the ear.

Will the graft be visible?

Grafts are carved and placed to follow the natural bridge line and are covered by skin and soft tissue; they should not be visible when well executed.

Where can I get an assessment?

Send photographs of your profile or book a consultation. Read about related cases in the revision rhinoplasty guide.

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About the author

Prof. Dr. Suleyman Tas is a European Board-certified plastic, reconstructive and aesthetic surgeon based in Istanbul with over 20 years of experience, author of Rhinoplasty in Practice (CRC Press) and founder of the Closed Atraumatic Rhinoplasty Course. Read verified patient reviews or book a consultation.

This article is for general information and does not replace an individual medical consultation.