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Introduction <p>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.</p> Methods <p>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.</p> Results <p>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.</p> Conclusion <p>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.</p> Level of Evidence IV <p>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 <a href="http://www.springer.com/00266">www.springer.com/00266</a>.</p>

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

  • 期刊论文

  • 发表日期：

    2026年6月21日

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  • Rosa Alessia Battista,
  • Milena Ferraro,
  • Alessandro Nobile,
  • Fabiola Munno,
  • Alex Finco,
  • Salvatore Carrabino,
  • Lucia Oriella Piccioni,
  • Mario Bussi

摘要

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.