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I had a rhinoplasty to remove a dorsal hump, do I possibly saddle deformity? (photo)

Hi all! I had a rhinoplasty to remove a dorsal hump a little over a year ago. I am assuming that by now the swelling has gone away. Unfortunately my nose still looks "deformed". At first I thought the surgeon simply left me with a small hump. However, now I worry that it is a saddle deformity. So my question is, from the pictures provided, do you think I do have a saddle deformity? 

Doctor Answers 7

It Might Be a Saddle Deformity- But That's Not Important

February 3rd, 2014
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In all honesty, whether or not it is a saddle deformity doesn't really matter. The bottom line- the swelling has essentially resolved and it doesn't look very good. The dorsum is bumpy and it is either too low for the tip or the tip is too high for the dorsum (depending on what you want your nose to look like at the end of the process). Ultimately the dorsum needs to be smoothed and either raised to match the height of the tip, or the tip needs to be lowered to match the height of the dorsum (again depending on whether you want your nose to be a bit bigger or smaller than what it is now). In either case, you will need a revision rhinoplasty. In order to help decide which way to go with the dorsum, a consult with an experienced rhinoplasty surgeon who does computer imaging as a part of their consult will give you an idea what the end result will look like, and should help with the decision making process. Good luck.
Michael R. Menachof, MD


Greenwood Village Facial Plastic Surgeon
4.4 out of 5 stars 26 reviews

I had a rhinoplasty to remove a dorsal hump, do I possibly saddle deformity?

February 2nd, 2014
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A closed rhinoplasty can be used to create a smooth dorsal aesthetic line.

Find a board certified plastic surgeon who performs hundreds of rhinoplasties and rhinoplasty revisions each year. Then look at the plastic surgeon's website before and after photo galleries to get a sense of who can deliver the results.

Kenneth Hughes, MD

Los Angeles, CA

Web reference: http://www.hughesplasticsurgery.com/Rhinoplasty.php

Kenneth B. Hughes, MD

Kenneth B. Hughes, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 439 reviews

Over-reduction

February 1st, 2014
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It appears that the surgeon may have over-reduced the cartilage just below where the bone ends on the roof of the nose.  Since your about 1 year after surgery, your changes are likely permanent.  There is not an adequate view from the front, but I expect that you are likely quite narrow in that middle nasal region.  The term "saddle nose" does not quite fit with your findings, but it doesn't really matter.  This is a very correctable problem (make the hump smaller while building up/likely widening a small amount the depressed cartilage area), but see a surgeon with extensive revision rhinoplasty experience.  You should end up happy with your nose in the end.
John Frodel, MD

John Frodel, MD
Atlanta Facial Plastic Surgeon
5.0 out of 5 stars 1 review

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Rhinoplasty

January 31st, 2014
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Based on the pictures posted it does not seem that you have a saddle nose deformity. You seem to have a persistent nasal hump and supra-tip depression. Will need a revision full Rhinoplasty
Samir Shureih MD. FACS
sshureih@msn.com
Samir Shureih, MD

Samir Shureih, MD
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Saddle deformity after rhinoplasty

January 31st, 2014
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this does appear to be a saddle deformity.  It would appear U had a reductive rhinoplasty where both the bone and the septal cartilage and upper lateral cartilages were reduced during the procedure.  Even with best intentions and techniques this does sometimes happen.  In your case to regain a more natural look he will need a revision that utilizes something called a "spreader graft."

Remember, there is no substitute for physical exam and in person consultation so please take my comments and advice with some limited weight.

Web reference: http://www.chaselaymd.com/facial-plastic-surgery/rhinoplasty.cfm

Chase Lay, MD

Chase Lay, MD
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One-year post-op saddle nose

February 3rd, 2014
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The cartilaginous component of the bridge line is too low in combination with a prominent rhinion which is too high. The bony dorsal hump should be shaved down and the saddle deformity built back up given even profile. For many examples of hump removal and treatment for saddle nose deformity, please see the link below

Web reference: http://www.seattlefacial.com/photogallery/rhinoplasty_photos24.html

William Portuese, MD

William Portuese, MD
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Saddle deformity after Rhinoplasty

February 3rd, 2014
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A saddle nose deformity if the result of loss of support from the septum, specifically the cartilage that makes up the septum.  This can happen from removing far too much cartilage, or from an infection after surgery the erodes all of the cartilage support.  If you press on the tip and saddled area of your nose and it is very soft and collapsible, then you might have it.  If you have lost support to your nose from loss of the septum, the reconstruction is complex.  However, I doubt that is what you've got.  The more common error and the one that I think your surgeon made was to remove too much cartilage from the dorsum (low area) and not enough of the bone (high area).  To fix this you would either need to build up the low spot and/or take down the high spot.  A pretty easy fix.  

Web reference: http://www.drjohnbitner.com/utah-facial-surgery-photos/2203-rhinoplasty/index.html

John Bitner, MD

John Bitner, MD
Salt Lake City Facial Plastic Surgeon
4.9 out of 5 stars 73 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.