Preventing Further Aging Nose

Question

Unfortunately I have a drooping nose and a wider tip due to a aging nose. I've read that the cause of a aging nose is due to a lack of support of the lower lateral cartilages. If I resolve the drooping nose and the wider tip through a rhinoplasty, is it wise to place a graft in the tip to prevent a further aging tip? Additional, what do you consider the best technique(s) preventing excessive scar tissue in the tip?

Kevin Sadati, DO · Answer

Dear rhinoplasty patient,
	The most frequent noticeable changes related to aging nose are in the tip area. Aging causes dropping of the tip down toward the floor and often inwards towards the face. This drooping of the tip causes a relative hump on the bridge but can also begin to cover up part of the upper lip, especially on smile. Some interpret this as &ldquo;growth of the nose&rdquo; but it actually stems from a weakening and loss of support. Restoring the tip to a more youthful position is a nice way to rejuvenate the nose with a somewhat subtle change. Many observers will not even recognize the nose has changed at all but the face appears more youthful and rested.
	Sometimes there is a loss of bone or soft tissue at the area of the base of the nostrils that causes the highest aspect of the upper lip to draw inwards. This contributes to the appearance of the tip of the nose dropping. Implants or grafts nicely rejuvenate this area for an even better result.
	Some individuals show profound affects of aging in their nasal skin. Surprisingly this area can become thin with age but occasionally a thickening will occur as evidenced with Rosacea. Evaluation of the skin is a necessary part of the evaluation of the aging nose and will play a role in the discussion about surgical options.
	Many other characteristics of the nose can be changed at the same time the aging changes are addressed to make the nose not only more youthful but more attractive. This can also improve breathing ability.
	An experienced rhinoplasty surgeon will be able to examine your nose and make a proper surgical planning. Good luck

Rod J. Rohrich, MD · Answer

The managment of the aging nose is challenging in that one needs to be very careful about doing too much in this patient group with fragile skin and weak cartilages and brittle nasal bones.   The best management axiom is-LESS IS MORE!

	This is what I mean-

	1. The nasal tip may droop and cause an apparent dorsal hump so an experienced rhinoplasty surgeon will elevate the nasal tip and miminize the dorsal hump reduction to restore the nose to a youthful appearance without dramatically changing the patient's nasal appearance.

	2. The Key element to correcting a drooping aging nasa tip is to resuspend the tip with a spanning suture to the nasal septum  and stabilize the tip  with a columellar strut .  Tip grafts are rarely needed if one uses the open approach to rhinoplasty which gives you the best opportunity to correct the aging nose.

	3. No osteostomies are needed in most patients as the nasal bones are quite brittle in older patients and can collapse the nasal vault .

	I think that correction of the aging nose or drooping nasal tip  is an important part of facial rejuvenation

Anthony Corrado, DO · Answer

The signs of aging with respect to the nose commonly involve nasal tip drop (ptosis), widening of the nasal tip, difficulty breathing secondary to valve collapse, and overall weakening of cartilage framework which makes up the nose. Rhinoplasty to address the aging nose requires careful attention to strengthening the cartilage framework. Nasal tip ptosis can be corrected with a columellar strut to provide tip support and projection. Nasal tip cartilages can be refined with tip suture techniques. Internal valve collapse can be addressed with spreader grafts to improve the airway and breathing. Lower lateral cartilage instabilities can be addressed with alar batten grafts, or lateral crural strut grafts. Lastly, scarring in rhinoplasty is best prevented by choosing a skilled revision rhinoplasty expert who utilizes sound surgical techniques. Good Luck....Dr. Corrado

Toby Mayer, MD · Answer

A properly performed rhinoplasty will reverse the aging deformities of the nose and you should have minimal changes of the nose after that.

Otto Joseph Placik, MD · Answer

This is an excellent question and if we knew we could probably prevent overall facial aging. To answer your quetion and batton style graft in the nasal tip could minimize the effects of aging cartilage and lack of support producing a sagging nasal tip.

Steven Wallach, MD · Answer

An aging tip may not need any cartilage graft support and may be lifted with suturing techniques alone.

Richard W. Fleming, MD (retired) · Answer

If the tip cartilages are weak, a cartilage graft will help support the tip to minimize the aging process. The best way to avoid excessive tip scar tissue is to select an experienced rhinoplasty surgeon.

Preventing Further Aging Nose

Answers (7)

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