Rhinoplasty in the Aging Nose

The Problem

Aging causes tremendous effects on skin and underlying structures of the nose. These changes may lead to nasal airway incompetencies and cosmetic deformities. Rhinoplasty in this group of patients needs specific evaluations and precise technique.

The Background

Age-related changes of the nose are extensively discussed in rhinoplasty literature. In general, the dermal layer of skin is attenuated and skin becomes relatively thinner. Nasal ligaments are weakened, leading to nasal elongation and tip ptosis. Nasal muscles undergo a relative shrinkage, and lower lateral cartilages show both mechanical and chemical involutions. These changes may lead to considerable nasal breathing problems. A pseudohump is another relatively common finding that shows a gradual deprojection of the nasal tip. In addition, the nasal tip loses its definition and looks larger.

Rhinoplasty in the aging nose needs a comprehensive preoperative evaluation to detect possible involutions of normal anatomic tissues. Many methods have been advocated to restore these changes. However, we (the authors of this chapter) usually try to avoid reduction techniques in aging noses or only do minimal reductions when needed. On the other hand, we use a vast variety of grafts to restore weakened anatomic architectures based on the specific indications.