Rhinoplasty for the Low Dorsum

(Saddle Nose)

Dallas rhinoplasty and cosmetic surgeon, Dr. Steve Byrd, dicusses his publications and approach to the saddle nose deformity.

The saddle nose nasal deformity is characterized by a dorsal nasal profile that falls more than 2-3 mm below the plane between the nasal tip and radix. These deformities may be from prior rhinoplasty (nose jobs), trauma, infection, cocaine use, or from congenital/developmental failures. Correction may be relatively simple requiring only dorsal augmentation are very difficult requiring replacement of the nasal structure. The key determinate for me is whether or not the nose has lost length and needs to be lengthened as well as augmented (see short nose). In my hands noses needing lengthening invariably require rib grafts to accomplish all goals whereas noses with adequate length may have simple augmentation to the dorsum.

In both of these cases the "saddle" deformity is masked somewhat by the loss of nasal tip projection. When the tip is brought to its ideal position, the bridge or dorsum is very deficient. In the first patient the apparent "bony" hump is actually the correct projection. The tip and cartilaginous dorsum were brought out so as to give a straight dorsal profile. On the second patient the entire dorsum and tip were brought out. Note how the added structure improved the relationship between the base of the nose and the lip.