Reconstructive Approach to Saddle Nose Deformity: A Diagnostic-Therapeutic Algorithm and the Preoperative Use of Hyaluronic Acid Filler for Skin Expansion in Rhinoplasty

Battista RA, Ferraro M, Nobile A, Munno F, Finco A, Carrabino S, Piccioni LO, Bussi M.

PubMed 42324394 Publisher (DOI)Free full text (PMC)

What this paper says

From 60 saddle-nose repairs by one surgeon, the authors built a step-by-step treatment algorithm and report the first use of hyaluronic acid filler to stretch contracted skin before reconstruction.

Overview

Saddle nose (a collapsed bridge) has many causes and degrees of severity. The authors reviewed 60 patients operated by a single surgeon between January 2016 and March 2023 and derived a flowchart covering classification, mucosal lining, skin quality and graft choice. Three cases illustrate the algorithm, including one in which filler was injected before surgery to expand tight skin.

Sections of note

Deformity types: 66.7% Type 1, 25% Type 2, 5% Type 3, 3.3% Type 4.
Septal perforation was present in 10% of cases.
Graft source: septal cartilage 55%, ear cartilage 28.3%, rib cartilage 15% for severe defects.
Skin integrity was assessed in every case; in one severely contracted case, preoperative hyaluronic acid expansion was used, described as the first reported application in saddle-nose reconstruction.
Level of Evidence IV.

What it means for a patient

Saddle-nose repair depends on three things: how much structure is missing, whether the inner lining is intact, and whether the skin can stretch over a rebuilt bridge.
Most cases in this series were mild and were fixed with septal or ear cartilage; rib was reserved for the worst 15%.
Filler as a pre-surgical skin expander was used in one patient only; it is a proof of concept, not an established step.

Why this paper matters

It offers a structured decision tool for a difficult reconstructive problem and introduces filler-assisted skin expansion. Limits: retrospective, single surgeon, no outcome scores reported in the abstract, the filler technique is a single case.

Terms

Saddle nose: a sunken bridge from loss of septal or dorsal support.
Septal perforation: a hole through the septum.
Mucosal lining: the moist inner skin of the nose.
Skin expansion: gradually stretching skin so it can cover a larger reconstruction.
Costal cartilage: rib cartilage, used when large amounts of graft are needed.

Summary written by rhinoplasty.cc from the abstract, 2026-09-08; not medical advice. The authors' own abstract follows.

Abstract

Introduction: Saddle nose deformity presents a major reconstructive challenge, requiring restoration of nasal function and aesthetics. Given its varied aetiologies and severity, a standardized approach is essential. This study proposes a diagnostic-therapeutic algorithm and highlights the preoperative skin expansion technique using hyaluronic acid fillers.

Methods: A retrospective study was conducted on 60 patients treated for saddle nose deformity between January 2016 and March 2023, all operated by a single surgeon. Based on clinical experience, a structured flowchart was developed to guide preoperative evaluation, treatment, and surgical planning. Three clinical cases were selected to illustrate its application.

Results: The algorithm integrates deformity classification, with 66.7% of cases classified as Type 1, 25% as Type 2, 5% as Type 3, and 3.3% as Type 4. Septal perforations were present in 10% of cases, and mucosal lining condition was crucial in planning. Grafting strategy varied: septal cartilage was used in 55% of patients, auricular cartilage in 28.3%, and costal cartilage in 15% for more severe defects. Skin integrity was systematically assessed; in one severe case of contracted skin, preoperative expansion with hyaluronic acid fillers was successfully performed, representing the first reported application in saddle nose reconstruction.

Conclusion: A standardized algorithm improves the management of saddle nose deformities by incorporating not only structural restoration but also careful evaluation of the mucosal lining and skin coverage. Detailed assessment, structured planning, and the use of filler-assisted skin expansion can significantly optimize both functional and aesthetic outcomes.

Level Of Evidence Iv: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Abstract as indexed by PubMed; the article is open access (PubMed Central).