Has anyone seen this nose cartilage loss/splitting before? (Photos)

Question

Nose basically symmetrical/no indentation before. Cartilage splits from bottom to top. Unfortunately, does not seem to be slowing down. Have seen 2 ENT doctors, they have not seen this in other patients. No past trauma/surgery/drugs. 50 year old male, physical/blood work, CPR High Sensitivity, ESR normal, no hypermobility. Anyone seen this in other patients? If so, were they fixable? Need help. Thank you for your input!

Mark Baldwin, MBBS · Answer

I can't imagine this is being anything other than age related changes causing cartilage bowing. I'm willing to give you the benefit of the doubt, that 2 previous surgeons said they'd never seen it before, and so you went off the deep end with Dr Google and annotated anatomical images. Otherwise, a 50 year old male is already ringing warning bells for me, so I'm going to say this. It's not 'fixable'. It's 'possibly improvable'. 
Best wishes.

Thomas A. Mustoe, MD, FACS · Answer

I have seen a similar situation before that was due to changes in nasal tip cartilage with age combined with thinning of nasal skin and subcutaneous tissues which made cartilage asymmetry more visible.  It could be improved with a tip rhinoplasty or possibly with a fat graft to soften it and thicken the subcutaneous tissue coverage.

Nima Shemirani, MD · Answer

Dear ctwr,The changes you are describing are pretty normal for someone who is 50.  The ligaments loosen over the years and this causes the "splitting" of the cartilages. The loss of fat, just under the skin, creates a thinner blanket of cushioning over your cartilages, thus exposing them more.  This happens to almost everyoneBest regards,
  
Dr. Nima
  
Member, American Academy of Facial Plastic and Reconstructive Surgery
  
Board Certified Facial Plastic Surgeon
  
Board Certified in Head and Neck Surgery

Scott Trimas, MD · Answer

It is probable that you have a high septum that is displacing your tip cartilages and creating some of the asymmetry. In addition, the two lower lateral cartilages that form the tip unit can separate over time especially if they are overly convex as yours appear to be. There is some truth that the nose grows with aging and that really means that the supporting cartilage and bone can weaken due to the weight of the skin and diverge. This can be corrected with a rhinoplasty procedure that takes some of the convexity out of the lower lateral cartilages, reduces the tension from the septum and then brings the two lower cartilages back together in the midline to straighten the tip and correct the asymmetries. I would recommend seeing a board certified facial plastic surgeon in your area since they typically  have the most expertise in rhinoplasty procedures and septal surgery.

Dean Fardo, MD · Answer

In some patients, the nasal tip complex can droop more as they age. This can accentuate any depression or irregularity in the lower lateral cartilage. This is not that uncommon and can usually benefit from a rhinoplasty procedure.  Tip defining sutures and a columellar strut are usually used to provide a more symmetrical and supported tip complex.  If the plastic surgeons you are seeing are not familiar or comfortable with this, then I would recommend another consult.  Good luck.

Greg Bran, MD, PhD · Answer

Hi there and thank you for your question. According to your photos and summary it is normal that your tip changes as we age. This is not caused by interruption  of the integrity of your  cartilages, but has more to do with continuous loss of  stability of nasal ligaments. As we age, these ligaments weaken and your tip defining cartilages begin to move away from each other. The age-related loss of skin thickness aggravates this, leading to the perception of splitting cartilage.
In case you are looking for a solution, you should consider an in-person consultation with an experienced rhinoplasty surgeon. Good luck.
GB

William Marshall Guy, MD · Answer

Hello ctwr,It looks more like your high septum is deviating to the left and the right lower lateral cartilage has a recurvature causing it to bend inward instead of outward.  This can happen with time or in those patients iwth previous trauma.  As the nose grows that small area of trauma begins to cause some of these deformities.  I would recommend you consult with a facial plastic surgeon if your are interested in correction.I hope this helps and good luck.

Andrew Kornstein, MD, FACS · Answer

In short, the answer is yes.Cartilage is inherently warped and asymmetrical; your tip cartilages are concave as opposed to the "norm," convex. You are noticing it now because the bony support system upon which the nose rests atrophies with age, altering nasal support, and your nasal skin thins with age----esp after age 50. In addition, your septum is deviated(high right to low left---if photo is not taken in a mirror) and your tip cartilages are congenitally(born that way) rotated up towards your eyes as opposed to horizontally towards your ears. Hope this helps.

Kyle T. Yamamoto, MD · Answer

As we age, the cartilage of the nose can become weaker, droop, or change in shape. Everybody ages differently, and it is possible that the changes you are seeing are due to how your nasal cartilages have aged over time.  Because you are continuing to see these changes progress, you would likely benefit from a rhinoplasty to increase the support of the nasal cartilages.  Using cartilage grafts (most often from your septum) to build a better support structure for your nose would be helpful in slowing the changes to your nose and give you an overall better shape.

Robert S. Schmidt, MD · Answer

Thanks for your question. Since you've never had a significant injury or surgery, there are a couple of things that could be behind this. I've seen a situation before where a blood vessel was running through the cartilage in about this region which could lead to it being rather weak. Another situation is that you had something called a nasal tip bossa and it is just becoming more pronounced with age. In any case these can be fixed with a rhinoplasty. I would probably use cartilage grafting to fix it, like something called a lateral crural strut.

Has anyone seen this nose cartilage loss/splitting before? (Photos)

Answers (10)

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