Nose deformity

What is a nose deformity?

A nose deformity is a change in the normal shape or structure of your nose, which can affect how it looks and how well you breathe. One well-documented example is saddle nose, where the bridge of the nose collapses and sinks inward, giving it a scooped-out, saddle-like shape.

What are the symptoms of a nose deformity?

Visible signs of a nose deformity such as saddle nose can include:

• a flat or concave (sunken) bridge
• an upturned nasal tip
• a horizontal crease across the lower part of the nose
• a nose that looks flattened or too wide compared with the rest of your face
• nosebleeds and crusting around the nose.

Some signs are not visible from the outside, including:

• a hole in the septum (the cartilage between your nostrils), known as a septal perforation
• breathing difficulties
• pain or discomfort in the nose.

What causes a nose deformity and who is at risk?

Most nose deformities happen when the bone or cartilage that supports the nose is damaged or loses its structure. This is most obvious in saddle nose, where the loss of support in the bridge causes it to sink inward.

Causes include:

• injury or trauma to the nose, which is the most common cause and can come from a direct blow, such as in boxing or contact sports
• complications from previous nose surgery, such as septoplasty or septorhinoplasty, if the septum was not given enough support or too much cartilage was removed
• autoimmune conditions that cause inflammation and damage cartilage, such as granulomatosis with polyangiitis, relapsing polychondritis, or systemic lupus erythematosus
• infections such as leprosy or syphilis, which can reduce blood supply to the nose
• long-term use of drugs such as cocaine, methamphetamine or crushed opioid pills, taken through the nose
• being born with the condition, or a congenital defect affecting the nasal bones or cartilage.

Are there different types of nose deformity?

Nose deformities can take several forms, including:

• saddle nose: the bridge collapses and sinks inward, giving a scooped-out appearance
• nasal hump: an overly large or bulging bridge, sometimes described as a step partway down the nose
• crooked nose: the bridge and tip do not sit in a straight line, often because of an injury to the nasal bones or a condition present from birth
• pinched tip: the tip of the nose is too narrow, tapering unevenly rather than staying a uniform width
• drooping nose: the tip points downward, which can look more pronounced alongside a nasal hump.

It is common to have more than one of these features at the same time. Saddle nose itself is often grouped into three stages, based on how much support has been lost:

• minimal: a small dip in the bridge
• moderate: a larger dip, with the nose looking flattened from all angles and the tip starting to turn upward
• major: an obvious loss of cartilage support, with the tip turned up significantly.

How is a nose deformity diagnosed?

A doctor or surgeon can usually diagnose a nose deformity during a physical examination. They will ask about your symptoms, including any breathing problems, and may take photographs to record how severe it is.

They will also ask what you would like your nose to look like, so they can plan treatment that is most likely to meet your goals.

How is a nose deformity treated?

Non-surgical treatment

Dermal filler injections, sometimes called non-surgical rhinoplasty, can even out mild dips in the bridge. Results are temporary and usually need repeating every six to 12 months, and filler cannot correct any breathing problems caused by the deformity.

Surgical treatment

Surgery is the main treatment for most nose deformities. Options include:

• rhinoplasty (a nose job), which rebuilds the shape and support of the nose using grafts of bone, cartilage or tissue
• septorhinoplasty, which combines rhinoplasty with work on the septum to improve breathing as well as appearance
• revision rhinoplasty, which may be needed if a nose deformity has developed as a complication of an earlier nose operation.

Surgeons usually prefer to use your own tissue for these grafts, most often cartilage taken from your septum, ear or rib, or bone from your pelvis (iliac crest). Rib cartilage is often used for more severe cases, as it gives strong, long-lasting support. In some cases, donor tissue or a synthetic material, such as silicone, may be used instead.

As with any operation, there is a chance of complications, including infection, the graft shifting out of place, or the graft changing shape over time. Most people feel better within a few weeks of rhinoplasty, though your nose will continue to heal for a year or more.

If your nose deformity is linked to ongoing drug use, your surgeon will usually ask you to stop for at least 12 months before surgery, and not to start again afterwards, to help your results last.

When should I see a doctor?

See a doctor or specialist surgeon as soon as you notice a change in the shape of your nose, especially if it is affecting your breathing. Nose deformities do not improve on their own, and early treatment tends to give more predictable results.