The Ageing Nose: Challenges and Solutions

Abstract

Purpose of Review Rhinoplasty has traditionally been considered an elective procedure for younger patients. However, increasingly older patients are undergoing nasal surgery for both functional and aesthetic indications. We provide an overview of the common problems with rhinoplasty in the elderly and the surgical techniques that can be reliably utilised to address them to produce predictable and longstanding results. Recent Findings Outcomes from studies of older rhinoplasty patients emphasise the need for a tailored approach that preserves natural structures. However, if reinforced structural support is required, especially in functional cases, grafting techniques such as septal extension grafts, spreader grafts and alar strut grafts are required. Furthermore, special consideration must be made for the nasal skin in older patients, and utilisation of dorsal onlay grafts is often necessary. Summary Surgery for the ageing nose is a complex challenge for the rhinoplasty surgeon. Preoperative assessment is critical and must include detailed facial analysis that considers the amplification of facial asymmetry due to the ageing process and an appreciation that expectations in this population may differ from younger patients. A comprehensive understanding of the age-related anatomical changes in the nasal structure and the wide repertoire of operative techniques are required to restore form and function.

Long‐Term Outcomes of Septoplasty With or Without Turbinoplasty: A Systematic Review

“…Another potential explanation of long‐term outcome changes is the impact of aging on nasal obstruction. Structural changes such as weakening of the fibrous connective tissue at the upper and lower lateral nasal cartilages, weakening of the septal cartilage, columella retraction, and drooping of the nasal tip all occur during aging, which together can lead to nasal valve collapse 74–76 . Mucosal blood flow, mucus viscosity, and nasal humidification can also change as one ages, leading to irritation in the nasal cavity 74 .…”

“…Structural changes such as weakening of the fibrous connective tissue at the upper and lower lateral nasal cartilages, weakening of the septal cartilage, columella retraction, and drooping of the nasal tip all occur during aging, which together can lead to nasal valve collapse. [74][75][76] Mucosal blood flow, mucus viscosity, and nasal humidification can also change as one ages, leading to irritation in the nasal cavity. 74 Whether these structural and mucosal changes occur quickly and substantially enough to affect outcomes several years after septoplasty remains unknown, and to our knowledge, no study has directly examined this phenomenon in the context of septoplasty.…”