How I Do It: The Role of Nasal Filler in Managing Cocaine-Induced Saddle Nose Deformity
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".