Rhinoplasty in the Older Adult

Background: Rhinoplasty in older adults requires unique consideration of the aging nose. Objectives: The purpose of this study was to systematically review the literature pertaining to rhinoplasty in the aging population, review the senior author's experience, and describe techniques aimed at addressing age-related features. It was hypothesized that consistent age-related nasal dysmorphology is described in the literature and standard rhinoplasty techniques may effectively address these changes. Furthermore, it was hypothesized that rhinoplasty is more commonly performed for posttraumatic and functional indications than for aesthetic reasons. Methods: A literature review including publications describing rhinoplasty in patients over 55 years old was conducted. Additionally, a retrospective review of the senior author's cases was performed. Pre- and postoperative photographs were used to compare anthropometric changes. Demographic factors, surgical indications, and operative details were collected. Results: Nine articles met the study criteria. Manifestations of the aging nose included soft tissue atrophy, bony fragility and resorption, tip ptosis, internal and external valve collapse, and worsening dorsal hump. Twenty-seven patients were included in this institutional review. Primary indication for rhinoplasty was posttraumatic deformity in 17 (63%) patients and nasal obstructive symptoms in 10 (37%) patients. Tip refinement and ptosis were addressed through tip grafts (70%), columellar struts (26%), and caudal septal extension grafts (67%). Nasal obstruction was relieved through septoplasty (96%), turbinate ablation (85%), and spreader grafts (70%). Conclusions: This study presents a systematic review of rhinoplasty in the older adult as well as a retrospective review of the senior author's patients. Unique considerations specific to this population should be integrated into treatment planning. Level of Evidence: 4