Rhinoplasty in the ageing face

Abstract

Ageing implies a process of irreversible deterioration following a peak in function. However, this deterioration affects different organ systems and tissues at different rates in the same person. Age-related changes in the nose affect all three layers and are predictable, although the extent to which they will affect a particular individual is not. There is loss of support from the soft tissues due to muscle atrophy and fatty infiltration into the superficial musculo-aponeurotic system (SMAS) layer. This causes sagging of the tip complex, while the thinner areas of skin show up any underlying structural irregularities. The end result of the changes is a long nose with an under-projected rotated tip, a dorsal pseudo-hump, and functional internal and/or external valve obstruction. These are the issues that should be considered and addressed during rhinoplasty in the older patient.