The mature nose

Abstract

The concept of rhinoplasty of the mature nose is presented. As an isolated procedure or in conjunction with other facial plastic procedures, shortening the length of a drooping nose can give the effect of a more youthful appearance. The anatomy and physiology of the nose as it ages is discussed and if understood by the surgeon, these patients need no longer be rejected because of their age. Technical consideration are important, and the use of the modified rim incision, high septal transfixion and lobule rotation is suggested. An analysis of 30 cases over a noe year period is documented to support this thesis.

Age‐related histologic and biochemical changes in auricular and septal cartilage

“…Although a common belief is that auricular cartilage in older patients is brittle and of poor quality, our histologic findings suggest that it may have superior integrity and viability to septal cartilage, and be less susceptible to age‐related cartilage degradation. In some cases, the donor site is dictated by the type of graft, such as septal extension grafts or auricular composite grafts.…”

Rhinoplasty in the Aging Nose

“…The normal tip support mechanisms, studied by Janeke and Wright, consist of (1) the fibrous connection between the upper and lower cartilages, (2) the sesamoid complex that attaches the lateral crura to the pyriform aperture, (3) the fibrous connections between the domes of the lower lateral cartilages, and (4) the attachments of the feet of the medial crura to the caudal septum. 9 With aging, all of these supports weaken, resulting in significant and distinctive changes in the nasal tip ( Fig.…”

“…The effects of aging on the infrastructure of the nose have been well delineated and previously reported. [1][2][3][4][5][6][7][8] To correct these changes, the tip must be rotated and reprojected. This can be accomplished with placement of a columellar strut and suture augmentation of the domes of the lower lateral cartilages.…”

Restorative Rhinoplasty in the Aging Patient

“…1,2 The drooping nasal tip often noted with the aging process is predominantly related to loss of fibroelastic support in the scroll area, which causes the lateral crura to migrate caudally. 5 Additionally, alveolar and maxillary hypoplasia, especially in the edentulous patient, results in loss of support for the nasal base and relative shortening of the columella. Thus, extrinsic and intrinsic loss of support of the lower lateral cartilages results in a drooping, elongated tip complex that impedes airflow into the nasal passages.…”

“…The drooping nasal tip often noted with the aging process is predominantly related to loss of fibroelastic support in the scroll area, which causes the lateral crura to migrate caudally 5 . Additionally, alveolar and maxillary hypoplasia, especially in the edentulous patient, results in loss of support for the nasal base and relative shortening of the columella.…”