Aging and the Nasal Skeleton
In addition to skin-soft tissue considerations, a successful rhinoplasty also demands a clear understanding of skeletal responses to surgical intervention. To fully appreciate these responses, one must first understand the impact of aging upon the nasal framework.
Life Cycle of the Human Nose
The human nose begins its life as a short, amorphous appendage, with few distinguishing characteristics. The nose remains child-like until puberty when the adolescent growth spurt triggers dramatic elongation of the nasal skeleton. By age 16, the nose reaches its final (and unique) adult shape as skeletal growth is now complete.
Yet adult nasal shape is far from static. Although the nasal skeleton will no longer grow after adolescence, numerous environmental and individual factors will impact nasal shape throughout the remainder of the human life cycle, producing subtle or sometimes even dramatic changes in the adult nasal contour. In other words, the nose will age just like everything else, and some noses age more than others.
Importance of Nasal Cartilage
Typically these changes are characterized by elongation and drooping of the tip, narrowing and collapse of the sidewalls, and thickening of the nasal skin. A visit to any nursing home will underscore the frequency of these age-related changes. The degree to which a given nose suffers this fate, and the speed with which these changes become evident, vary widely according to a host of independent factors. Foremost among these is the intrinsic strength and rigidity of the cartilage framework. For those born with stiff, rigid nasal cartilage, age-related changes are less likely to affect the nasal contour. In contrast, those born with soft, flaccid nasal cartilage may readily succumb to age-related changes in nasal shape. Moreover, individuals afflicted by nasal allergies, circulatory compromise (e.g. diabetes), prior nasal trauma, cumulative sun damage, and/or nicotine use may experience accelerated deformity of the nasal contour despite initially strong nasal cartilage.
Unfortunately, the impact of nasal aging is generally detrimental, as breathing often deteriorates and the nose typically becomes less attractive with age. The susceptibility of the nose to aging underscores the importance of preserving structural support when undertaking cosmetic rhinoplasty. Rhinoplasty techniques that remove or destroy nasal cartilage are ill-advised since they may predispose the nose to premature aging.