Written and medically reviewed by Dr Nizar Hamadeh, MD, MSc (Plastic Surgery), Consultant Plastic Surgeon on the GMC Specialist Register for Plastic Surgery. GMC number 7009480. Last reviewed: 4 October 2026.
If the bridge of your nose has started to dip, or looks flatter than it used to, you may have been told you have a saddle nose. The dip changes your profile, and for many people it also makes breathing harder. In most cases the bridge can be rebuilt with surgery once the cause is known and under control. This is a specialist form of rhinoplasty (nose surgery). At his Harley Street practice, Dr Hamadeh corrects it with structural rhinoplasty in London, which rebuilds the support that has been lost.
What is a saddle nose?
A saddle nose is one where the middle of the nasal bridge has sunk, so the profile dips between the bony upper part and the tip, like the curve of a horse’s saddle. It happens when the septum, the wall of cartilage that holds up the middle of the bridge, weakens or is lost. Doctors call it saddle nose deformity and describe it as a depressed nasal dorsum (the dorsum is the medical name for the bridge). It is sometimes called a boxer’s nose, because injury is a common cause.
What are the early signs and symptoms of saddle nose?
The early signs are often small. Many people first notice a slight dip in the bridge in photos, or a profile that looks different from before. Others first notice a blocked feeling or difficulty breathing through the nose. Crusting, nosebleeds and a whistling sound when you breathe in can point to damage or a hole in the septum, and are worth checking with a doctor.
How is saddle nose classified by specialists?
Specialists usually grade the deformity from mild to severe, based on how much support has been lost, and the grade guides how it is corrected:
- Mild. A small dip, with the rest of the profile in balance and the septum still largely supportive.
- Moderate. A clear dip, often with some difficulty breathing and a shorter-looking nose.
- Severe. Much of the structural support has gone, the bridge looks flat and the tip may turn upwards.
What are the causes of a saddle nose?
The bridge sinks when the septum can no longer support it. The main causes are:
- Injury. A break or a hard knock can damage the septum. If a collection of blood forms inside it (a septal haematoma) and is not drained quickly, it cuts off the blood supply to the cartilage, which can then break down.
- Previous surgery. If too much cartilage is removed during a septoplasty or rhinoplasty, too little may be left to support the bridge. Correcting this is a revision operation.
- Infection. An abscess in the septum can destroy cartilage.
- Autoimmune and inflammatory conditions. Granulomatosis with polyangiitis (formerly called Wegener’s granulomatosis) and relapsing polychondritis can attack nasal cartilage.
- Cocaine use. Cocaine damages the lining and cartilage of the septum and can cause a hole (septal perforation) that leads to collapse of the bridge.
Rare causes include congenital syphilis, which is now very uncommon in the UK. Finding the cause matters, because it decides when surgery is safe and how the bridge should be rebuilt.
Does a saddle nose get worse over time?
It depends on the cause. A saddle nose caused by a single injury or by earlier surgery usually stops changing once the nose has healed. A dip caused by an active process, such as untreated autoimmune disease, an ongoing infection or continued cocaine use, can keep getting worse as more cartilage is lost.
That is why the cause needs to be found before any correction is planned. See a doctor if the bridge keeps changing shape over weeks or months, or if breathing is getting harder. If an inflammatory condition is possible, your GP can arrange tests and a referral. Surgery is planned only once the condition is controlled, usually with the agreement of the specialist treating it, such as a rheumatologist.
How is saddle nose deformity diagnosed?
Saddle nose is diagnosed with a physical examination. The surgeon looks at your profile, checks how firm the bridge feels and looks inside the nose, often with a thin camera (nasal endoscopy), to see whether the septum is damaged or has a hole. If an autoimmune condition is possible, blood tests may be arranged, and a CT scan is sometimes used to assess the bone and cartilage before surgery.
Can a saddle nose affect breathing?
Yes, often. The same loss of support that lowers the bridge can narrow the internal nasal valve, the narrowest part of the airway, which makes breathing harder. A collapsed bridge can also sit alongside a deviated septum, which can be corrected in the same operation. Surgery therefore usually aims to improve breathing as well as shape, and both are assessed at your consultation. Read more about combined septorhinoplasty.
How is a saddle nose corrected?
A saddle nose is corrected with surgery that rebuilds the missing support using cartilage grafts. This is a form of structural rhinoplasty, sometimes called saddle nose rhinoplasty. The operation restores the height of the bridge and, where needed, strengthens the septum and opens the airway. Because grafts need to be shaped and stitched precisely, it is usually done with the open approach; our guide to open vs closed rhinoplasty explains the difference.
The process usually follows these steps:
- Assessment. Dr Hamadeh examines the inside and outside of the nose, checks your breathing and asks about the cause.
- Choosing the graft. The cartilage used depends on how much support is needed and how much is available (see the table below).
- Rebuilding. The graft is shaped and placed to restore support to the septum and height to the bridge.
- Breathing correction. Any narrowing of the airway is corrected in the same operation where possible.
| Cartilage source | When it is used | Trade-off |
|---|---|---|
| Septum | Small corrections, when enough healthy septum remains | No extra incision, but often too little is left after injury or previous surgery |
| Ear cartilage | Small to moderate rebuilding | Small incision behind the ear; the cartilage is curved and softer |
| Rib (costal cartilage) | Larger rebuilding, when a lot of support is needed | Provides the most cartilage, but adds a small chest incision and a longer recovery |
If the dip followed an earlier operation, the correction is also a revision. Our page on revision rhinoplasty in London explains how second operations are planned.
Can filler fix a saddle nose?
Dermal filler can disguise a mild dip for a period of months, but it does not rebuild support or improve breathing. Filler in the nose also carries a small but serious risk of blocking a blood vessel, which is higher where the tissues are scarred from injury or surgery. When the cartilage support has truly been lost, surgery is the lasting option.
What are the risks of saddle nose surgery?
Saddle nose correction carries the general risks of any rhinoplasty, including swelling, bruising, bleeding, infection, numbness, asymmetry and a result that does not fully match what you hoped for. Grafting adds some specific risks:
- Warping. Rib cartilage can bend slightly as it settles, which can change the line of the bridge.
- Resorption. Part of a graft can be absorbed by the body over time, reducing the height gained.
- Visible or palpable edges, especially under thin skin.
- Donor-site effects, such as discomfort or a small scar behind the ear or on the chest.
- The need for further surgery, which is more likely in severe or revision cases.
The risk of the dip returning is higher if the original cause, such as autoimmune disease or cocaine use, is still active. At your consultation, the risks that apply to your nose specifically are explained in detail.
What is recovery like after saddle nose correction?
Recovery is similar to other rhinoplasty with grafts. The first one to two weeks are the most noticeable, with swelling, bruising and a blocked nose, and most people take about two weeks off work. If rib cartilage is used, the chest is also sore for a few weeks. The shape continues to refine over several months, with the tip usually the last area to settle.
For a week-by-week picture, see our guide to rhinoplasty swelling stages.
What affects the cost of saddle nose correction?
The cost depends on how much rebuilding is needed, which graft source is used, whether breathing correction is included and whether it is a first or a revision operation. Your personalised quote is given after your consultation.
When should you see a surgeon?
See a surgeon when the shape of the bridge has been stable for some time and any medical cause has been treated or ruled out. Book earlier for an assessment if the bridge is still changing or your breathing is getting worse.
It helps to bring details of any previous surgery and a few photos from before the shape changed.
Frequently asked questions
Is saddle nose surgery available on the NHS?
The NHS may fund nasal surgery when it is needed to restore breathing or to repair recent injury, depending on local criteria. Surgery to change the appearance of the nose is not funded. Our guide to septoplasty on the NHS vs private explains how the criteria work.
How long does saddle nose correction last?
Cartilage grafts are intended to give long-term support, and once the nose has settled the result is usually stable. A small part of a graft can be absorbed over time, and the result is more likely to change if the original cause is still active.
How long after a nose injury should I wait before correction?
A suspected septal haematoma needs urgent treatment straight away. For the dip itself, surgeons usually wait until the nose has fully healed and the shape has been stable for several months.
Can a saddle nose be corrected after cocaine use?
Sometimes, but only after a sustained period without cocaine and once the lining of the nose has healed. Any hole in the septum is assessed first, because continued use damages grafts and makes the dip likely to return.
Considering saddle nose correction?
If the bridge of your nose has dipped, the first step is an examination to find the cause and check your breathing. At 10 Harley Street, Dr Hamadeh assesses the inside and outside of your nose, explains how the bridge could be rebuilt and follows the Royal College of Surgeons’ two-stage consent process, with a cooling-off period before any decision. You can start with an initial video call, but surgery is only ever planned after an in-person examination. He operates at The Fitzrovia Hospital, the Cadogan Clinic and HHV.
Book a consultation with Dr Nizar Hamadeh
About the author
Dr Nizar Hamadeh is a Consultant Plastic Surgeon on the GMC Specialist Register for Plastic Surgery (GMC 7009480), seeing patients at 10 Harley Street, London. He qualified in medicine in 1997, trained in otolaryngology and head and neck surgery at university hospitals in Paris and Brussels, and holds an MSc in Plastic Surgery. His practice focuses on aesthetic and functional rhinoplasty, including septorhinoplasty, structural and revision surgery, alongside facial rejuvenation. He operates at The Fitzrovia Hospital, the Cadogan Clinic and HHV. He was a finalist for Best Surgical Result at the Aesthetics Awards 2025. Read Dr Hamadeh’s full profile.
Sources
- NHS: Nose reshaping (rhinoplasty)
- BAPRAS: Rhinoplasty patient information
- Royal College of Surgeons: Professional Standards for Cosmetic Surgery
Medical disclaimer
This article is for general information only and does not replace a personal consultation with a qualified doctor. Every nose is different and results vary. If you have concerns about your nose or your breathing, speak to your GP or a qualified specialist.