Morphological abnormalities in wild animals can be indicators of the underlying health of a population and may be determined through routine photographic surveys. Here, we assess unusual rostrum conditions in Indian Ocean humpback dolphins (Sousa plumbea) inhabiting South African coastal waters to understand the rate of prevalence of abnormal rostrums and formulate hypotheses on potential causes. Photographic data were collated from systematic boat surveys and opportunistic sightings, obtained between April 1998 and March 2021 in various regions along the South African coast. Overall, 31 unique individuals were found with abnormal rostrum conditions, varying from slight misalignments to severe wounds and/or aberrant morphologies. In most cases, injuries were likely caused by natural events during the animal's life history such as interactions with sharks and/or reef‐associated hunting strategies. Mark–recapture data indicated that individuals had survived with these injuries for up to 10 years. This study reports the highest incidence of rostrum abnormalities in the species. As numbers reflect only those that have survived their injuries, they are considered a minimum estimate. A better understanding of the cause(s) of these injuries is important given the endangered status of this species. This study highlights the highest incidence of rostrum abnormalities identified for the species, but numbers presumably only reflect those that have survived their injuries and are, therefore, a minimum estimate for these animals. A better understanding of the cause(s) of these injuries is deemed important to be considered when revisiting the endangered status of this species.