How Young is Too Young for Rhinoplasty?

We are often asked to perform rhinoplasty in young adolescents. Nasal surgery on children has long been a focus of discussion in the medical literature. As experts in rhinoplasty and nasal surgery, at Profiles we believe that discussion regarding nasal surgery in children has to be divided between functional surgery and cosmetic rhinoplasty.

When dealing with children with functional problems, surgery such as septoplasty can be done as early as necessary in order to restore nasal function and to prevent the consequences that may arise due to misplaced anatomic structures. In these patients, extra care must be taken to preserve as many structural supports and as much septal continuity as possible in order to insure normal nasal growth.

When considering cosmetic surgery of the nose, we generally believe surgery should be delayed until the nose is fully grown. This commonly means rhinoplasty can be done on girls when they have had their period for at least 2 years and in boys when they are at least 14 years old.

Another good indicator of nasal growth is the patient's height compared to their parents. If the patient is as tall as their tallest parent, then they are probably finished growing and so has their nose. Exceptions for younger children are made for those patients who have a significant anatomic deformity and a very strong desire for surgery to correct it.

The problem with operating on patients earlier than these target ages is that the nose may continue to grow in an unpredictable fashion. So, despite creating a balanced nose after the rhinoplasty, the continued nasal growth can distort the proportions that were created.

Finally and perhaps more important than the physical maturity, we also believe that all our adolescent patients must have the emotional maturity to deal with their surgery. It is very important that the patient himself/ herself is interested in having the surgery and that it is not only being done because the parent wants surgery.

With all of this said, we believe that the psychological benefit that rhinoplasty can afford during puberty, a very critical time in emotional development, is significant and should be considered for the right patients.

Rhinoplasty is a surgical procedure to reshape the nose. Many young patients may arrive at the office to learn about the procedure. The age range of the patients seeking this procedure is trending lower. This is a function of our society and the age in which patients begin to take great care in their personal appearance.
From a surgical standpoint two important considerations determine when a rhinoplasty should be performed. The first consideration is the physiology, growth and development of the nose. The second is the psychological maturity of the patient undergoing the procedure.
The nose completes most of its growth generally by age 15 in women and age 17 in men. To operate on the nose at an earlier age may affect growth and development. However, not all patients are equal, and it is best to look at other characteristics of puberty and maturity to correlate with the nasal growth to estimate when the maximal growth is complete.
The psychological maturity is a much more difficult factor to assess. We all know that our thinking as a 17 year old is much different than our thinking as a 30 year old. In most places consent can be legally obtained from a 16 year old. However, a surgeon is ethically bound to a much higher standard. It is best to take a careful history and make sure that the client fully understands the surgery, along with the risks and benefits. Consultation with the parent and also alone may be beneficial. The history should also carefully rule out Body Dysmorphic disorder (abnormal preoccupation with body image), early onset depression or schizophrenia or any other emerging psychological condition. If this is suspected in the history, a prompt referral to a psychiatrist for further evaluation may be beneficial prior to considering any surgical procedure. The surgeon must assess how the patient will tolerate the immediate post operative procedure with a potential for pain and discomfort.
In general, the best approach is to carefully assess the patient and the family. No surgeon can give a definitive age as to when to perform a rhinoplasty on a younger patient. Performing a procedure at 18 or 21 or even later can be the best approach in many cases. The surgeon never regrets the patient he has not operated on. The goal of the surgery is to provide benefit for the patient and avoid any psychological or physical adversity
 

My philosophy on female Rhinoplasty differs from male Rhinoplasty.  In case of my female patients if they are less than 18 years of age, I look at photos and ask the parents to make sure that the nose has stopped changing for at least 6 months.  Usually this occurs by the age of 16 in females as in males it may be beyond the age of 18.

Rhinoplasty is a popular and effective surgery to recontour the shape of your nose. In our practice, we ask that parents wait for their children to be in their late teenage years before considering a rhinoplasty. The maturity of the patient and their understanding of the procedure is essential.
Keep in mind that even small changes to your nose can create a dramatic change in your overall appearance. For this reason, it is essential that you work with a board-certified plastic surgeon who has a great deal of experience in rhinoplasty.
 

Because the chin and the nose are usually the last structures to reach adult size, you want her to wait until she has fully grown. This is usually between 15 ands 16 for girls and 17 and 18 for boys.

Rhinoplasty can be performed on age 16 for females and 18 for males.  The nasal bone growth plates have not finished growing until that point, thus cosmetic Rhinoplasty surgery should be withheld until the face is fully developed.

In general you would not want to perform a cosmetic rhinoplasty ("nose job") on someone whose face has not stopped growing.

In general, most people finish growth in the midface where the nose sits around the age of 15. Surgery prior to this time period may negatively affect growth in other areas of the face creating problems in facial harmony. Hope this helps.

If you asked every cosmetic surgeon in Phoenix this question, you’d get a wide range of different answers. I am typically very conservative when it comes to performing surgery on younger patients, and my Scottsdale rhinoplasty patients are no exception. Although last year in the U.S. more than 17,000 nose surgery procedures were performed on patients younger than 18, I generally prefer that patients have reached adulthood before making any decisions about plastic surgery.

I want to be sure that my patients are physically and emotionally mature enough to respond well to their surgery. For some patients, this may be true at 16, but for others, growth continues through the teens. If rhinoplasty is performed for teenager whose nose shape is continuing to change, the changes occurring after surgery may create aesthetic or functional problems. Additionally, I want to be sure that all of my cosmetic surgery patients have carefully considered their procedure and recovery, and that they have realistic expectations. Teenagers are more prone to impulsive decisions and are often influenced by peer pressure, and some teens may not be emotionally ready to permanently change their appearance.

There are exceptions, however. Some teenagers mature earlier, both physically and emotionally. There are also cases such as injuries or nasal deformities that may warrant surgical correction at an earlier age. In my opinion, the only way to determine if someone is old enough for rhinoplasty is through a careful evaluation, and open discussion between the surgeon, the family, and the patient.

Cosmetic surgery should not be entered into lightly. It is best to ensure that your daughter has reached physical maturity and is emotionally able to handle the surgery.  My rule of thumb when asked this question is to consult with 3 surgeons and unless there is unanimous agreement amongst the surgeons that she is a candidate then wait. 

An aesthetic rhinoplasty should not be performed on patients younger than 16 years of age.  It is preferable to wait until 18 years of age to allow for further growth and maturation of the facial skeleton.  This needs to be treated on a case by case basis however most plastic surgeons would tend to follow this age range for cosmetic nasal surgery.  If you or your child has breathing difficulty, then a rhinoplasty and/or septoplasty may be performed sooner.

Consult with a board certified plastic surgeon prior to scheduling a rhinoplasty procedure.

Best wishes,

Dr.Bruno