What Is Saddle Nose? Causes, Symptoms, and Surgical Treatment
Nasal Cartilage Deficiency: When Aesthetic Concerns Affect Breathing
A nose without bone is unimaginable — likewise, a nose that lacks cartilage or has insufficient cartilage is also impossible. The shape and beauty of the nose are formed by the underlying bone and cartilage, while the skin of the nose merely covers these structures.
Nasal Skeleton and Structure
The upper part of the nose, near the forehead, is made of bone and is rigid. However, the lower part (closer to the lip) is composed of cartilage and is flexible. This mobile structure allows the nasal tip to withstand mild pressure and gives it elasticity.
Why Does the Nasal Framework Collapse?
Nasal collapse occurs mainly as a result of weakening in the skeletal support of the nose. The most common causes include:
- Failed previous surgeries
- Congenital anatomical conditions
- Trauma or injury to the nose
What Happens When Cartilage Is Missing?
When there is a deficiency of cartilage in the nose, a key sign is nasal valve collapse, where the nostrils close inward during breathing, functioning almost like a “valve” that blocks airflow.
The cartilage of the nasal wings (alar cartilages) helps keep the nostrils open — but these same cartilages can make the nose appear wider cosmetically. If cartilage is removed excessively in attempts to narrow the nose, this can lead to both aesthetic problems and breathing difficulties.
Cartilage Loss in the Nasal Septum and Saddle Nose
If the cartilage deficiency occurs in the middle support structure of the nose, known as the septum, the nasal bridge collapses. This condition is known medically as “Saddle Nose Deformity.”
Instead of excess tissue, the fundamental issue in saddle nose deformity is a lack of structural support. Therefore, typical cosmetic techniques such as shaving bone or cartilage do not resolve the problem and may even worsen it.
How Is Saddle Nose Treated?
The primary principle of treating saddle nose deformity is to rebuild and reinforce the collapsed nasal framework by replacing the missing tissues. This process is known as augmentation rhinoplasty (or nose reconstruction with grafts).
To restore the nasal dorsum (bridge) and return it to its original height and function, cartilage or bone must be harvested from:
- Ear Cartilage (Auricular Cartilage)
- Often the first choice if the nasal septum cartilage has already been used or is insufficient.
- Harvesting cartilage from behind the ear does not affect hearing and leaves the scar well hidden.
- However, ear cartilage alone may sometimes be too soft to fully support the nasal bridge.
- Rib Cartilage (Costal Cartilage)
- In more severe cases or in revision surgeries, rib cartilage provides a stronger and more reliable structural support.
- It is usually abundant and can be carved precisely for reconstruction.
- Cadaveric Cartilage (Allografts)
- In rare cases where the patient prefers not to use their own cartilage, medically processed donor cartilage may be used, though autologous tissue (the patient’s own cartilage) remains the gold standard.
Surgery and Recovery Process
These reconstructive procedures are typically performed under general anesthesia. The surgeon meticulously sculpts the harvested cartilage and places it into the collapsed nasal framework to restore both aesthetic harmony and functional breathing.
The goal is not just to make the nose look better, but also to improve nasal airflow and overall function. A successful surgery should result in a natural-looking nose that is harmonious with the rest of the face, with breathing restored.
Rebuilding a collapsed nasal framework requires much more experience and precision than simply reducing or reshaping the nose.
