Is this saddle nose? Can it be repaired? (Photo)

Question

I have had two recent Sinus surgeries/septoplasty. I had a post op SSI after the first surgery in Jan 2014. I had another surgery in 2015 for recirculation. I have continued to have infections in my nose and am constantly on antibiotics. My nasal bone is very tender and appears bruised, red or even broken. Can the infection be in that part of my nose? Can it be repaired? Thank you!

Steven M. Denenberg, MD · Answer

Click on the "Web reference" link, just below my response, or go here:

FacialSurgery.com/RealSelf/RealSelf_meippolito.html

I made a computer morph of your nose, and an animation of the morph, to show the changes that are possible for your nose in truly expert hands.

From an appearance aspect, it looks as though more needs to be done to your nose. In the morph, I simulated elevating the tip, lowering the bump on the bridge, and bringing the entire nose back closer to your face, especially the top of the nose, where it begins just below the eyebrows. You'll probably see that best in the animation. I'd love to hear what you think about the morph.

The other views you posted show that your tip is wide, too, and that can be narrowed.A "saddle nose" is where the bridge has collapsed in, or down, and is way too low. But your bridge is still too high, so it's not a saddle.

It's very unusual for a nose to have a lingering infection that cannot be promptly resolved with antibiotics; that's the kind of thing that I'd have to see you in person to evaluate.

You should understand that the changes I demonstrated in the morph require advanced techniques, techniques that most plastic surgeons cannot handle.  Be sure to read the section in the "Web reference" link on how to stay out of trouble while searching for a rhinoplasty surgeon.

Your nose is also a good example of why computer imaging is mandatory in rhinoplasty. You need to know exactly what the surgeon is planning to accomplish -- what features he thinks he can change, and by how much he thinks he can change them. When you see his goals, you'll know whether he has an eye for a beautiful nose, and whether he shares your opinion of what constitutes a beautiful nose. You'll also know whether the changes he proposes are enough to be meaningful to you, and whether he understands your wishes enough to address all of your priorities. But remember, you're not hiring him for his skills with the computer. The doctor must then show you his before and after photos to prove that he can actually accomplish what he draws on the computer.

Fred J. Bressler, MD, FACS · Answer

Yes, it does appear that you have developed a saddle deformity of the middle vault region of your nasal dorsum. Infection, scar contracture after septoplasty, revision septoplasty, septal perforation are unfortunately common causes of this condition. Other conditions such as Wagener's Granulomatosis, Middle line granuloma, fungal infections, substance abuse can also lead one to this condition. I am concerned about the persistent infections you describe. Best to boost your immune system or identify the nature of your infections and try to resolve these issue prior to repair. Tissue cultures and biopsies may be helpful. On a positive note, when your infections clear and you have a good understanding that you do not suffer with Wagener's or other conditions, a reconstructive rhinoplasty can repair your nose. Consider consultation with an infectious disease specialist as well as your ENT/ Facial Plastic Surgeon.

Is this saddle nose? Can it be repaired? (Photo)

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Is this saddle nose? Can it be repaired? (Photo)

Answers (2)

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Recommended reading

Everything you need to know about Septoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.