Excessive Facial Aging After Rhinoplasty?

Question

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.

Michael A. Persky, MD · Answer

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

Daniel Reichner, MD, FACS · Answer

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.

Otto Joseph Placik, MD · Answer

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.

Steven H. Williams, MD · Answer

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.

Frank P. Fechner, MD · Answer

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

Excessive Facial Aging After Rhinoplasty?

Answers (10)

Answer: Facial aging after Rhinoplasty unlikely

Answer: Facial aging after Rhinoplasty unlikely

Answer: Non-surgical treatments may be the answer

Answer: Non-surgical treatments may be the answer

Recommended reading

Everything you need to know about Rhinoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.

Excessive Facial Aging After Rhinoplasty?

Answers (10)

Answer: Facial aging after Rhinoplasty unlikely

Answer: Facial aging after Rhinoplasty unlikely

Answer: Non-surgical treatments may be the answer

Answer: Non-surgical treatments may be the answer

Browse related questions

Recommended reading

Everything you need to know about Rhinoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.