How I Do It: The Role of Nasal Filler in Managing Cocaine-Induced Saddle Nose Deformity

Saddle nose deformity is most often the result of intranasal cocaine use, but it may also occur in autoimmune conditions such as granulomatosis with polyangiitis (GPA). Many of these patients are poor candidates for surgical reconstruction because of poor vascularity, ongoing substance use, or large septal perforations, making rib grafting and traditional techniques high risk. In our practice, we have managed this challenging group with injectable filler as a minimally invasive alternative. Between January 2020 and June 2025, 6 patients with cocaine-induced saddle nose deformity were treated in an outpatient setting using Revanesse Sculpt. Outcomes were assessed with standardized pre- and posttreatment photographs and Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) scores obtained at baseline and 3 months. Patients demonstrated visible cosmetic improvement with restored contour and symmetry. All procedures were well tolerated under local anesthesia. To our knowledge, this represents one of the first detailed descriptions of a systematic filler technique for managing saddle nose deformity in this high-risk population. This approach provides a safe, cost-effective, and reproducible method for temporary correction when surgical reconstruction is not feasible.