Rhinoplasty in the Older Adult

Overview

The ageing nose has thinner soft tissue, brittle bone, a drooping tip, collapsing valves and a more prominent hump. The Yale authors reviewed the literature on rhinoplasty in patients over 55 and retrospectively reviewed the senior author's cases, comparing pre- and postoperative photographs and recording indications and techniques.

Sections of note

• Nine articles met criteria.
• Age-related features: soft-tissue atrophy, bony fragility and resorption, tip ptosis, internal and external valve collapse, worsening hump.
• 27 institutional patients: post-traumatic deformity 17 (63%), obstruction 10 (37%).
• Tip: tip grafts 70%, columellar struts 26%, caudal septal extension grafts 67%.
• Obstruction: septoplasty 96%, turbinate ablation 85%, spreader grafts 70%.

What it means for a patient

• Older adults mostly seek rhinoplasty for injury or breathing, not cosmetic change, and the operations lean on structural support for a drooping tip.
• Brittle bones and thin skin change surgical risk and technique; an experienced surgeon will plan for them.
• The series is small and the review found only nine relevant articles.

Why this paper matters

It is one of few papers focused on rhinoplasty after 55, combining a review with a case series. Limits: 27 patients, single surgeon, no outcome scores in the abstract.

Terms

• Tip ptosis: drooping of the nasal tip with age.
• Nasal valve collapse: inward buckling of the side wall on inhalation.
• Caudal septal extension graft: cartilage extending the front of the septum to hold the tip up.
• Turbinate ablation: shrinking the turbinates to improve airflow.
• Soft-tissue atrophy: thinning of skin and underlying tissue with age.