Is this saddle nose? (Photos)

Question

Septoplasty & turbinate reduction 6 weeks ago. Staph infection, cellulitis; procedure done to drain septal abscess 5 weeks ago. Straight nose before, now bridge dips and it might be wider. Is this saddle nose and what is the recommended correction? My ENT said he would take cartilage from my ear and put it into the bridge of my nose. If I decide to have corrective surgery how long should I wait and should I go to the ENT who did my septoplasty, or should I go to a plastic surgeon?

Alejandro Nogueira, MD · Answer

My sympathy with you and your surgeon, this is a dramatic complication no one wants to meet ever in life, actually I did many many septal works and never experienced such problem, but well, it is well-known and has to be detected on time and, as your doctor correctly did, drain the abscess.But the abscess is a simple way call the real condition you have suffered, which is called chondritis: the bacteriae grow underneath the perichondrium sheath in an avascular plane (at least poorly vascular) and literally "eat" and make the cartilage disappear.It seems the chondritis affected not only the septum but also the upper lateral cartilages and the dorsal support, that is what you devoloped a saddle nose deformity, true name.Solution is correct, dorsal grafting from ear concha, but things are not that simple and magical, some warnings:-I don't know if your surgeon has skills in these procedures, do find out, if he has experience in REVISION AESTHETIC rhinoplasties then he should do the repair, otherwise do request from him escalating the case or seek the technical support of an experienced colleague-the tissues need a cool down perion of no less than 1 year after these major infections-the cartilage graft might be not enough if the skin is thin and lets visibility of the grafted dorsum, in such cases an additional temporalis fascia graft is bound as safety camouflageIf properly done the repair can achieve 100% your preop. aesthetics.If you wish better grounded opinion please do post or send privately well lit, focused and standard images: frontal, both lateral and both oblique views, also underneath the nostrils.
Feel free to request any additional information from me.

Nirmal Nathan, MD · Answer

Unfortunately it does appear you've developed a saddle deformity after the infection. Infections happen, and it just matters how you are treated from this point forward. Personally, I would advise against any onlay grafts or injections/implants to correct the deformity. This is because poor septal support could also have functional implications for your nose as well.

I use cartilage grafts to correct a saddle nose, but something stuffer such as rib. This will restore the structural integrity of your nose. I would also recommend waiting a year before doing any revisionary surgery. I think an ENT or plastic surgeon is appropriate, as long as they have experience/training in facial skeletal surgery. This can be accomplished through a craniofacial or facial plastics fellowship. Hope this helps.

Eric M. Joseph, MD · Answer

A septal abscess may lead to collapse of the lower bridge of your nose which is a form of "saddle nose", except your profile has a small bump. If your frontal view is acceptable to you, you may wish to consider microdroplet Silikon-1000 injections to permanently raise the areas above and below your profile hump for a straighter nasal profile appearance. 
If you require surgery, it may be best to consult with several reputable rhinoplasty specialists so you could see what might be best moving forward. Dorsal augmentation may be performed with different products. We prefer ePTFE(GoreTex) sheets from Implantech that may be custom carved. You may have thin skin, and ear cartilage grafting may lead to irregularities. Wishing you all the best moving forward. Dr Joseph

Sumit Bapna, MD · Answer

It appears that you are developing a saddle nose because of the loss of cartilage from your infection. I would wait for this to declare itself completely for about year so you can determine how much cartilage needs to be added to improve your profile. You may need structural grafting to improve your breathing if it gets worse over the course of the year. Rib cartilage may be your best option if you need multiple  larger grafts.

William Portuese, MD · Answer

Yes, from the limited photographs and does appear that there is a combination of a saddle nose and the residual dorsal hump present.  The residual dorsal hump that is present makes the saddle nose. look worse.  Since it has only been a few weeks since this issue occurred,  it is best to wait at least 1 year to allow full healing before undergoing a revision rhinoplasty.

Fred J. Bressler, MD, FACS · Answer

Thanks for your post. I am sorry that you suffered with a septal abscess which complicated your surgery for septoplasty. Unfortunately it does appear that you are developing a nasal saddle deformity which is a well known sequela to a septal abscess. I would wait at least 8 to 12 months from surgery before correction. Your nose is still healing and the tissue may further contract or change. Best to wait for all the tissues to settle down before reconstructive rhinoplasty repair. Cartilage grafts offer superior options over injections or implants generally. Sometimes acellular tissue grafts are used together with cartilage. I suggest you consult with an experienced Facial Plastic Surgeon for recommendations.

Is this saddle nose? (Photos)

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