The Aging Nose and Plastic Surgery

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Beth Longware Duff, Medical Editor

Beth Longware Duff is an experienced writer and reporter whose work on a wide variety of topics has been published in numerous newspapers and magazines. Her health and medical writing credits include nationally distributed videos for the March of Dimes Birth Defects Foundation, and she is the recipient of numerous awards including an American Cancer Society Media Award and a New England Press Association Award for Health Reporting. She holds a degree in Communications from Ithaca College.


June 26 2008

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Cosmetic plastic surgery lately has seemed like the domain of the young, but it has plenty to offer the young at heart, too. For example, rhinoplasty can benefit seniors who are dealing with both the cosmetic and functional issues associated with the aging nose.

"A lot of older people who have rhinoplasty are interested in improving their ability to breathe as well the outer appearance of their nose," explains J. Randall Jordan, MD, FACS, a board-certified plastic surgeon and Associate Professor of Otolaryngology at the University of Mississippi at Jackson. "Many of the things that we do to rejuvenate the appearance of the aging nose, like lifting the tip back and turning it up, also can help with the airway."

A marvel of form and function, the nose is a delicate amalgam of skin, bone, cartilage, blood vessels, and nerves that are essential for breathing and for our sense of smell. It is divided into two parts, external (the nose you can see) and internal (the nasal cavity). Both are split vertically by a thin piece of cartilage and bone called the nasal septum. This creates a wall between the nostrils and the two hollow passageways (nares) that extend upward and inward into the nasal cavity and then connect with the sinuses to form the upper end of the respiratory system.

"What typically happens as a person ages is that their nasal airways become narrower and the nose becomes narrower," notes Dean M. Toriumi, MD, FACS, a board-certified plastic surgeon and Professor in the Department of Otolaryngology in the College of Medicine at the University of Illinois at Chicago. "As that occurs, the tolerance of the airway decreases, so what may have been a breathable airway in their twenties suddenly becomes a compromised airway in their fifties. You need to not only correct the septum but any type of collapse as well."

The nose doesn't actually continue to grow past our mid-to late-teens. Rather, the effects of gravity and the loss of support and elasticity of the tissues cause the cartilage to weaken and the tip to droop over time, making it look longer. "As we age, the nose loses shape and contour, the fatty structure and some of the elasticity, and the cartilage gets brittle," says board-certified plastic surgeon Rod Rohrich, MD, FACS, Chairman of the Department of Plastic Surgery at the University of Texas Southwestern Medical Center in Dallas.  

The resulting tip ptosis, or sag, is not only cosmetically objectionable to some people, but it can cause functional problems as well. "When the tip becomes ptotic, it also causes internal collapse and obstruction to the airway, which is called nasal valve collapse," says Dr. Jordan. "When the tip droops, it brings out the hump on the nose, or dorsal convexity, which can be corrected by repositioning the tip or reducing the hump."

A deviated septum (when the septum leans to the left or right of the center of the nose) can also worsen with age. It is often caused by an impact trauma to the face, or it may be the result of the nose being compressed during birth. Many people whose septal deviation was negligible when they were younger will start to notice it when they hit middle age. It can usually be corrected with a minor surgical procedure called a septoplasty.

Dr. Rohrich, who calls rhinoplasty "a surgery of millimeters" and deals primarily with cosmetic surgery patients, notes that he takes a much more conservative approach with a patient over the age of 50 than he would with a younger patient. "They already have such a tremendous imprint on their brain of their facial image and personality that you have to do truly minimal changes to their nose," he points out. "You can't do a 35-year-old rhinoplasty on a 56-year-old. That will not go over well psychologically, physically, or aesthetically. You have to be age congruent with gender and with their psyche."

Fewer than 14,000 patients over the age of 50 had rhinoplasties in the United States in 2007, according to statistics from The American Society for Aesthetic Plastic Surgery. But Dr. Toriumi predicts that number will climb in coming years. "Because of the number of baby boomers out there, this type of surgery is becoming more common," he says. "There are other aids that people use, such as Breathe Right® strips, which can help as well. But at some point a lot of these patients decide they want a permanent correction."