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Excessive Facial Aging After Rhinoplasty?

I just turned 26 who had Rhinoplasty a year and a half ago at 24. I have noticed what I believe to be extreme and embarassing aging in that time, including permanent nasolabial wrinkles, crows feet, and bags under my eyes no matter how much I sleep. I actually asked my plastic surgeon at about 6 months after, if he had ever seen sagging or problems with extra skin after Rhinoplasty, and he told me it was just aging. However, he has not seen me more recently and it seems this really is excessive aging for a 26 year-old.

I have seen from others on this site for the first time that experienced similar fat loss and drooping, which is interesting and validating. I have had some weight loss in this time, but probably not more than 5-10 pounds. However, I am about 115 at 5'6" so maybe this amount has more impact. I have also developed permanent red spots on the sides of my nose, where it looks hollow (don't wear glasses).

Question is, what are your opinions on whether this is excessive or not, causes, and especially your recommendations the best solutions for a 26 yo. It seems young to have a face lift, but I also would not want to do injections every 5 months for the rest of my life. My skin is also sensitive and laser skin resurfacing seems like something that would scar, or that Sculptra would be most likely have bad side effects for me.

I feel vain to want plastic surgery solutions so badly, but it is so dramatic that I no longer feel attractive with permanent wrinkles and eye bags no matter how much I sleep, and just feel too young for this.

Doctor Answers 10

February 22nd, 2009

5- 10 lbs weight loss can make a difference

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The pictures you show do not validate your extreme concerns. However, 5-10 lbs of weight loss can certainly make your face lose enough volume to make the difference. At your age you can help yourself with good skincare: Retin-A Antioxidants, Sunblock, Alpha Hydroxy acids, routine skincare, non-foaming cleansers, exfoliants, and good moisturizers.

Robert M. Freund, MD
February 21st, 2009

Beauty is in the Eyes of the Beholder, but Sometimes Fractional CO2 Will Help

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Hi Charlie,

First of all you need not feel unattractive. You look very attractive in all of your pictures. If it is the crow's feet, the muscular roll under your eye, and nasolabial folds, a fractionated CO2 laser treatment (Fraxel re:pair, Deep FX, Mixto, SmartXide Dot) may be your answer.

Remember that if you do nothing at all, you are still a very attractive young lady. Good luck and be well.

Dr. P

Michael A. Persky, MD

Michael A. Persky, MD
Encino Facial Plastic Surgeon
4.8 out of 5 stars 36 reviews

February 21st, 2009

Rhinoplasty does not contribute to facial aging

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I would agree with my colleagues statments.

At 5'6" your "ideal" body weight is closer to 130lbs. Make sure you have adequate nutrition which can dramatically effect the condition of your skin and contribute to a healthy youtful appearance. Make sure you are not malnourished and that you are sufficiently supplementing your diet with vitamins.

Gaining 10 pounds may be the easiest and quickest fix. If not, contemplate facial fat grafting for a more long-term solution.

Otto Joseph Placik, MD
February 21st, 2009

Facial aging after Rhinoplasty unlikely

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Thanks for the question.

First, it is unlikely that a Rhinoplasty in itself caused accelerated facial aging. It is possible that after investing time, money and pain from recovery and surgery, you are paying more attention to your face and becoming more critical of yourself.

Doctors often encourage patients to bring in these types of pictures, but it is important to realize their limitations. I think your pictures have relatively good consistency of the position of your mouth, but in some of them you are squinting somewhat secondary to the sun or lighting. Consistent photos (same camera, same lighting, same distance, same background) are critical for true comparisons. All that being said, I do think that your nasolabial folds are somewhat more pronounced.

This may be part of your normal aging. Different people obviously manifest signs of aging differently because of differences in environment, skin elasticity, facial structure and many other factors.

A ten pound weight loss is likely not overly significant in the formation of crow's feet or deeper nasolabial folds. It typically requires greater weight loss to manifest concerns you address in someone who is relatively young (your skin tone is more resistant to these wrinkles when you are younger).

My first piece of advice would be to take a deep breath. If these issues really bother you there are permanent effective, low scar techniques like fat grafting to soften these lines.

For younger patients that have these concerns, we typically recommend trying a facial filler because it is temporary. If our patients like the results, we can perform fat grafting with virtually no scar. They've done quite well with this two stage process.

I hope this helps.

Steven H. Williams, MD
February 20th, 2009

Rhinoplasty doesn't cause aging

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Rhinoplasty doesn't cause the aging changes that you are concened about. It is difficult to see in the pictures what bothers you. Smoking and sun exposure can impact aging skin the most. Also light hair and light eyes, which often coincide to fair skin will predispose you to early aging. Skin care products will help with the fine lines. Bags under your eyes may be excess herniated fat, but you are a bit young for that.

Steven Wallach, MD
February 20th, 2009

Non-surgical treatments may be the answer

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Your rhinoplasty likely did not cause the change in your facial features. Sometimes though, successful nasal surgery may allow a patient to "move on" and notice other issues.

Your weight loss of 10lbs is significant and can contribute to facial volume loss - one of the issues we encounter in most young patients. Many long distance runners or triathletes in their early or late 20s may have similar concerns. We usually treat this with injectables for volume restoration (i.e., Radiesse, Sculptra, Juvederm).

Facial fat grafting is another option although we like to combine it with other treatments that require a recovery anyway.

I hope this helps.
Frank Fechner

Frank P. Fechner, MD

Frank P. Fechner, MD
Worcester Facial Plastic Surgeon
4.6 out of 5 stars 50 reviews

May 19th, 2009

No correlation between excessive facial aging and a rhinoplasty surgery

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There is no correlation between excessive facial aging and a rhinoplasty surgery. Nasolabial wrinkles, crow’s-feet and bags under the eyelids are not related to any rhinoplasty surgery.

William Portuese, MD
February 21st, 2009

Rhinoplasty not directly related to facial aging

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Charlie,

Rhinoplasty will not have a direct influence on facial aging, but I believe that in some patients the osteotomies (breaking the nasal bones) can alter the tear trough area and enhance lower eyelid bags.

It is true that facial aging is related to age, genetics, skin elasticity, weight gain and loss, smoking, sun exposure, and exposure to free-radicals that break down skin and the supporting soft tissue.

I think that many patients have the wrong concept about taking care of their faces. They are looking for a one-time treatment that will keep them young - like a face lift. The reality is that cosmetic medicine is more about preventing aging and adding specific treatments that make a big difference.

Taking care of your face is similar to taking care of your teeth, you need routine maintenance and specific repairs as needed. I would start you with a computerized digital UV photograph of your face to determine the amount of sun damage. Based on your photographs, I would also recommend correction of your tear trough with micro fat or 2 to 3 cc's of hyaluronic acid. I would start you on daily sunscreen with UVA and UVB protection, Obagi Healthy Skin Protection, and IPL photo-facial treatments. We would photograph your face before every maintenance visit to document your progress and address any problem areas.

Daniel Reichner, MD

Daniel Reichner, MD
Newport Beach Plastic Surgeon
4.9 out of 5 stars 49 reviews

February 20th, 2009

A little maintenance is all you need

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First of all, your aging is not excessive. You look great in the pictures. Yes, you are getting some lines, but they are probably related more to the sun damage and genes, thin fair skin is more prone to early changes. What you call the bags under your eyes are more likely just a prominent muscle ridge. Some people tend to get them. None of it is related to rhinoplasty. Your rhinoplasty results looks actually quite good. I think the timing is coincidental, and you are just starting to notice some changes.

What can you do about it? First of all - prevention. Do not smoke and use sun protection - all the time. For your type of skin it is really important. Use sunscreen and good moisturizers, including the area around eyes, every day. Get sleep, stay hydrated, all the regular things.

Second, and you might not like it, but it might be the time to start judicial use of Botox and filler injections. A little botox around your eyes will prevent further wrinkles and make them better. I have some patients with similar problems in their twnties, and we usually have to use only a small anoumt of Botox or fillers for maintenance.

Find a good reputable and supportive doctor and you will do well.

Stella Desyatnikova, MD
Seattle Facial Plastic Surgeon

February 20th, 2009

Rhinoplasty cannot cause aging

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Charlie C,

There is nothing inherent in rhinoplasty that would cause facial aging or the appearance of aging. Rhinoplasty can cause individuals to look at themselves differently however. If nasal shape has been an issue holding you back personally, sometimes having reached this goal can cause a focus shift.

At the age of 26, two of the best things you can do for yourself are sun protection, and avoiding smoking and smokers. After protection you might consider some nonsurgical treatments which can help in a subtle way. Light based therapies such as IPL or photofacial is safe for almost all and can solve the problem of red spots along the side of the nose. Botox may be helpful along the corner of the eye or crow's feet area. Also rather than start injectable fillers, consider small structural fat grafts.

Fat grafting from the hip or tummy is very helpful to fill lower lid hollows, cheek hollows, and deep smile lines, all with natural tissue. If well done grafts can be permanent and will keep your face youthful without frequent retreatments.

At just 26 focus on skin care, life, and fun. You are pretty in pictures, so keep smiling.

Best of luck,

peterejohnsonmd

Learn more: http://www.peterejohnsonmd.com/rhinoplasty

Peter E. Johnson, MD

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.