Journal archive · by topic
The growing nose and the ageing nose
The same operation is a different problem at twelve and at seventy: in a child the fear is stunting a nose that has not finished growing, and in an older patient the nose has kept changing, dropping at the tip, thinning at the skin and weakening at the cartilage, until it blocks the airway. Both ends of that range are thinly studied compared with the twenty-five-year-old cosmetic patient who fills most of this literature, and the strongest finding at each end is the same: the operation is safer than the field long assumed.
Where these 28 papers were published
- 6Facial Plastic SurgeryFacial Plast Surg
- 5Facial Plastic Surgery and Aesthetic MedicineFacial Plast Surg Aesthet Med
- 5Aesthetic Surgery JournalAesthet Surg J
- 4Aesthetic Plastic SurgeryAesthetic Plast Surg
- 3Plastic and Reconstructive Surgery Global OpenPlast Reconstr Surg Glob Open
- 2Facial Plastic Surgery Clinics of North AmericaFacial Plast Surg Clin North Am
- 2Plastic and Reconstructive SurgeryPlast Reconstr Surg
- 1JAMA Facial Plastic SurgeryJAMA Facial Plast Surg
23 further papers on this topic came in through the history rather than the archive query: Romo T 3rd 2003, Leong SC 2010, Tasca I 2011, Reitzen SD 2011 and 19 more. They are counted on the landmark papers, not here.
What repeats
Five findings reported by independent groups. Each card carries the papers it rests on.
Operating on a child's nose does not appear to stop it growing
The historical rule was to wait until skeletal maturity at eighteen, on the grounds that surgery would damage the growth centres. Animal work, then paediatric sinus and septal surgery studies, then the cleft literature all point the other way: growth is not measurably affected when cartilage-sparing and preservation techniques are used. Twenty-five studies of primary cleft rhinoplasty at the time of lip repair include eight of nine that specifically examined growth and found no restriction. The remaining caution is honest: long-term outcome data in the non-cleft child are still described as elusive, and a small variation in a child's nose can become a visible deformity in an adult's.
Rests on: Shave et al., paediatric functional rhinoplasty · Johnson, management of paediatric nasal surgery · Zelko et al., primary cleft rhinoplasty reviewed.
In children the indication is usually the airway or trauma, not appearance
Paediatric nasal surgery is mostly done after injury or for obstruction, and treating obstruction in a child is itself framed as protecting facial growth rather than risking it. Aesthetic rhinoplasty in children and adolescents is discussed separately and carefully, the psychological questions that surround it are the same ones that surround adult cosmetic surgery, arriving earlier.
Rests on: Johnson · Shave et al. · House et al., aesthetic rhinoplasty in children and adolescents.
The nose keeps changing after the rest of the face has stopped
The ageing nose has a described pattern: the tip drops as the cartilages weaken and the ligaments stretch, the nose lengthens, the skin thins and loses elasticity, bone resorbs. That is the mechanism behind the commonest complaint in older patients, a nose that both looks longer and works worse. Reviewing the literature on patients over 55 alongside one surgeon's series, the indications skew functional and post-traumatic rather than aesthetic, and standard techniques address the changes when the plan accounts for them.
Rests on: Toriumi and Rosenberger, rhinoplasty of the ageing nose · Khetpal et al., rhinoplasty in the older adult.
Functional nasal surgery in older patients is a growing part of the workload
Analysing Medicare procedure data from 2000 to 2019: use of the functional rhinoplasty codes rose, septoplasty and inferior turbinate reduction rose, and the shift tracks the recognition that the internal and external valves, which weaken with age, are where the resistance is. This is the only population-level utilisation dataset on file for any part of rhinoplasty.
In an old nose, the skin is the operation's limit
Thin, inelastic skin over a nose being reduced leaves redundancy that does not redrape, and a drooping tip that returns. Twelve patients over 50 had lenticular skin excised along the radix as part of the operation to take up that slack, and skin excision has been described to correct a hypertrophic tip in an elderly patient. The general rule the soft-tissue literature gives is to assess the envelope before choosing what to do underneath it, including with ultrasound, which measured 75 primary patients' skin against a pinch test.
Rests on: Caterson et al., skin excision in middle-aged and elderly patients · Bertrand et al., skin excision for a hypertrophic tip · Kosins and Obagi, measuring the soft-tissue envelope · commentary.
By age
What the operation is for, and what limits it, at each stage of life.
Childhood
Almost always trauma or obstruction. The techniques are cartilage-sparing and conservative, and the endpoint is a nose that grows normally. Long-term growth data are the gap: they exist for cleft repair and barely for anything else.
Key papers: Shave et al. · Johnson.
The cleft child, where surgery is planned into growth
The one paediatric population with long follow-up. Overcorrection at the primary repair holds to skeletal maturity; nostril retainers and nasoalveolar moulding shape the nose before and after; the intermediate operation in mixed dentition is the contested one. The full account is on the cleft nose.
Key papers: Murali et al., overcorrection at maturity · Huang et al., morphology after facial maturation · Abdurrob et al. · Ng et al., eighteen years of intermediate rhinoplasty · Al-Qatami et al., nostril retainer.
Adolescence
The age at which cosmetic requests begin and at which the nose is usually, but not always, finished. The paediatric literature treats it as a judgement about maturity rather than a birthday, and the psychological questions are the adult ones, which is why what the patient expects, and why they came, is worth measuring before agreeing. Personality and adverse childhood experience are now being studied as inputs to the decision itself: in 256 people, neuroticism raised the likelihood of having had rhinoplasty by 16.3%, rising to 29.3% when a family member had had one.
Key papers: House et al. · Yılmaz et al., childhood trauma and personality traits · and the psychology of rhinoplasty.
Middle age
The point at which the tip has started to drop and the skin no longer redrapes as tightly. Skin excision enters the toolkit here, and the soft-tissue envelope assessment matters more than in a twenty-year-old.
Key papers: Caterson et al. · Kosins and Obagi.
Older adults
Functional and post-traumatic indications dominate; the valves are weaker, the cartilage softer and the skin thinner. Utilisation of functional nasal procedures in this group has risen for two decades. Population data also show what the baseline is: satisfaction with one's own nose rises with age, so the older patient who presents is, on average, less driven by appearance than the younger one.
Key papers: Khetpal et al. · Geelan-Hansen et al. · Kasapov et al., population normative data · Toriumi and Rosenberger.
Any age, when the skin has been damaged
Previous surgery, radiation, smoking or age all reduce what the envelope can survive. The revision literature's algorithm for a compromised skin-soft tissue envelope (prevention, early recognition, timely intervention) applies with more force the older the patient is.
Key papers: Deot and Nassif, salvaging the compromised envelope · Kosins and Obagi.
The terms, defined
Every term the papers above use to mean something specific, in plain language.
- Growth centres: the areas of the septum and nasal skeleton believed to drive nasal growth in childhood; the reason surgery on children was avoided for decades. [28340652, 37619608]
- Skeletal maturity: the point at which facial growth is complete, conventionally around 16 to 18; the traditional threshold for elective rhinoplasty. [37619608, 37797231]
- Cartilage-sparing technique: conservative paediatric surgery that repositions rather than resects, on the assumption that removed cartilage cannot grow. [37619608]
- Tip ptosis: the drooping of the nasal tip with age, from weakening cartilage and stretching ligaments; the commonest structural change in the ageing nose. [26862965, 33739380]
- Skin–soft tissue envelope (SSTE): the skin, fat and muscle over the framework. Thick envelopes hide detail; thin, inelastic, older skin cannot redrape over a reduced framework. [27965218, 42091325]
- Lenticular skin excision: removing a lens-shaped strip of nasal skin, usually at the radix, so redundant skin does not bunch after a reduction in an older patient. [26579338]
- Nasal valve compromise: weakness or collapse of the internal or external valve; the age-related cause of obstruction behind the rise in functional procedures. [33847511]
- Functional rhinoplasty CPT codes: the billing codes (30400, 30410, 30420, 30465) used to track how often the operation is done in a health system. [33847511]
- Nasoalveolar moulding and nostril retainer: the non-surgical shaping used before and after cleft lip repair in infancy. [35787611]
- Overcorrection: deliberately setting a child's cleft nostril beyond symmetry because it relapses as the face grows. [36730430]
The papers this rests on
The 12 papers everything above was written from. Every one links to its abstract, its authors and its DOI.
- FPS Pediatric Functional RhinoplastyShave S, Vella J, Chandy B2023PMID 37619608Summary
- FPSAM Consideration of Aesthetic Rhinoplasty in Children and AdolescentsHouse AE, Itamura K, Azizzadeh B2023PMID 36048532
- FPS Clin 2017PMID 28340652Summary
- ASJ Rhinoplasty in the Older AdultKhetpal S, Gowda AU, Parsaei Y et al.2021PMID 33739380Summary
- FPSAM Use of Functional Rhinoplasty in the Aging Nose: Medicare Database AnalysisGeelan-Hansen K, Were V, Miller M et al.2022PMID 33847511Summary
- FPS Rhinoplasty of the Aging NoseToriumi DM, Rosenberger E2016PMID 26862965Summary
- ASJ External rhinoplasty by skin excision to correct hypertrophic tip of an elderly patientBertrand B, Georgiou C, Degardin N et al.2015PMID 26508652Full text
- PRS-GO Skin Excision as an Adjunctive Technique to Rhinoplasty in Middle-Aged and Elderly PatientsCaterson SA, Singh M, Kueckelhaus M et al.2015PMID 26579338Summary
- ASJ 2017PMID 27965218Summary
- ASJ Commentary on: Managing the Difficult Soft Tissue Envelope in Facial and Rhinoplasty SurgeryGruber RP, Shih HB, Lin WC2017PMID 28052908
- FPS Clin 2026PMID 42091325Summary
- APS Childhood Traumas and Personality Traits' Impact on Rhinoplasty DecisionYılmaz Y, Aksoy A, Altuntaş EE2024PMID 39285056Summary
What is still contested
- Whether elective aesthetic rhinoplasty is ever appropriate before skeletal maturity is a judgement, not a finding; the paediatric literature states it as a judgement. [36048532, 28340652]
- Long-term growth data outside cleft care are described in the paediatric reviews themselves as elusive. Nothing on file follows a non-cleft child operated at twelve into adulthood. [28340652]
- The ageing-nose literature is one systematic review with a single surgeon's series attached, plus technique papers. There is no cohort comparing techniques in patients over 65. [33739380]
- Skin excision in older patients rests on twelve cases and a case report. [26579338, 26508652]
- Utilisation data exist for one country's older population and nothing else; nobody knows how the age distribution of rhinoplasty is changing anywhere else. [33847511]
- Outcome instruments are not age-normed. The one population dataset shows satisfaction with one's own nose rises with age, which means the same score means different things at 25 and at 65. [42670247, 26063837]
The raw extraction, line by line: the audit trail behind the synthesis above
Frequently asked questions
The questions people search, answered from the paediatric and ageing literature.
How old do you have to be for a rhinoplasty
The historical rule was to wait for skeletal maturity at eighteen, on the grounds that surgery would damage the growth centres. The evidence points the other way: eight of nine studies that specifically examined nasal growth after primary cleft rhinoplasty found no restriction. The remaining caution is honest, long-term outcome data in the non-cleft child is still described as elusive, and a small variation in a child's nose can become a visible deformity in an adult's.
Rests on: Zelko et al., primary cleft rhinoplasty reviewed · Shave et al..
Why do children have rhinoplasty at all
Usually for the airway or after an injury, rather than for appearance. Treating obstruction in a child is itself framed as protecting facial growth rather than risking it.
Rests on: Johnson, management of paediatric nasal surgery.
Does a nose keep changing with age
Yes, after the rest of the face has stopped. The tip drops, the skin thins and the cartilage weakens, and in an older patient that sequence is what blocks the airway.
Rests on: the ageing nose papers.
Is rhinoplasty safe in an older patient
Both ends of the age range are thinly studied compared with the twenty-five-year-old cosmetic patient who fills most of this literature, and the strongest finding at each end is the same: the operation is safer than the field long assumed.
Rests on: the papers on this page.
Written by rhinoplasty.cc from the PubMed abstracts, 2026-09-09. Not medical advice.
Related topics
Septum, valve and airway
15 of the 28 papers here also match this topic.
Anatomy and nasal analysis
14 of the 28 papers here also match this topic.
Outcomes, satisfaction and psychology
9 of the 28 papers here also match this topic.
Dorsum and hump
7 of the 28 papers here also match this topic.
Every paper, by year
28 papers. The 12 above are not repeated.
20261 papers · 1 above
20241 papers · 1 above
20236 papers · 2 above
- FPSAM Accuracy of Surgeon Predictions in Rhinoplasty Outcomes Using Computer Imaging: A Quantitative Analysis of Dorsal HeightHarounian J, Tham T, Dodhia S et al.PMID 35506909
- FPSAM Commentary on: "The Use of Acellular Human Dermis as a Dorsal Camouflaging Graft in Rhinoplasty" by Melancon et alSharma JM, Sherris DAPMID 36637870
- FPSAM The Use of Acellular Human Dermis as a Dorsal Camouflaging Graft in RhinoplastyMelancon CC, Challapalli S, Kridel RWHPMID 36637866Summary
- PRS-GO Comparing Postoperative Taping vs Customized 3D Splints for Managing Nasal Edema after RhinoplastyPatel A, Townsend AN, Gordon AR et al.PMID 37744773Summary
20221 papers · 1 above
20212 papers · 1 above
- APS Application of Three-Dimensional Imaging in Asian Rhinoplasty with Costal CartilageLi W, Liang Y, Sun Y et al.PMID 33432387Summary
20202 papers
- ASJ Rhinoplasty: A Sequential Approach to Managing the Bony VaultZholtikov V, Golovatinsky V, Palhazi P et al.PMID 31157882Summary
- PRS-GO Use of the Autologous Membrane in Structured Rhinoplasty: An Alternative to Camouflaging and Fillingda S Neto MP, de S Almeida ÉC, da C C Tiveron LR et al.PMID 32983802Summary
20182 papers
- APS Three-Dimensional Imaging in Rhinoplasty: A Comparison of the Simulated versus Actual ResultPersing S, Timberlake A, Madari S et al.PMID 29789868Summary
- FPS PMID 29857339Summary
20176 papers · 3 above
- APS Use of Computer Imaging in Rhinoplasty: A Survey of the Practices of Facial Plastic SurgeonsSingh P, Pearlman SPMID 28432415Summary
- FPS PMID 28388789
- PRS Managing Alar Flare in RhinoplastyRohrich RJ, Malafa MM, Ahmad J et al.PMID 29068925Summary
20165 papers · 1 above
- FPS Evolution of Preoperative Rhinoplasty Consult by Computer ImagingLekakis G, Claes P, Hamilton GS 3rd et al.PMID 26862968Summary
- FPS Three-Dimensional Surface Imaging and the Continuous Evolution of Preoperative and Postoperative Assessment in RhinoplastyLekakis G, Claes P, Hamilton GS 3rd et al.PMID 26862969Summary
- JAMA FPS A Staging System for Revision Rhinoplasty: A ReviewRodman R, Kridel RPMID 27149684Summary
- PRS Digital Imaging in Secondary RhinoplastyLehrman CR, Lee MR, Ramanadham S et al.PMID 27219263Summary