The shape of the nose can change with aging
- Why does the nose shape change with aging? (soft tissue, bone structure, past surgical history, etc.)
- Where should you look? A self-check to objectively evaluate the changes in your own nose
- What is the role of the "support structure" that supports the height of the nasal tip?
- Treatment options for changes in the nasal tip, and the merits and demerits of each
"I feel like the tip has become rounder and dropped compared with before..." That may be a sign that multiple factors are involved—changes in cartilage or bone structure due to aging, or the effect of past rhinoplasty. In this article, we explain concretely the points for objectively viewing the changes in your own nose and the treatment options.
About changes in the nasal tip due to aging
The decline in cartilage elasticity and its effect on the support structure
Just as the facial skin changes with aging, the internal tissue of the nose also changes. This change has large individual differences depending on skin thickness, bone structure, lifestyle, and so on, but it is mainly related to atrophy of the soft tissue, sagging of the skin, and remodeling of the craniofacial skeleton (bone resorption and reconstruction).
The bone and cartilage of the nose are no exception. Structural changes accompanying aging may reduce the elasticity of the nasal cartilage and decrease the force supporting the tip (tip support).
The cartilage that firmly supported the tip in youth gradually loses its tension and rebound force with age. As a result, it may give way to gravity and the weight of the surrounding skin, and the tip may come to look round and drooping.
The effect of bone-structure atrophy on the nasal tip
Another factor that drops the tip is atrophy of the facial bone structure. In particular, as resorption of the bone of the maxilla (upper jaw) progresses, the rim of the piriform aperture (the pear-shaped opening in the nasal part of the skull) gradually recedes.
As the bone that forms the foundation thins, the force supporting the tip from the base is affected, and it can become one cause of tip droop. However, the degree of the effect of facial bone changes on the tip has large individual differences, and it is important to understand that it is complexly related to other factors such as skin sagging and changes in the cartilage itself.
As a treatment option, an approach can be considered that corrects the depression around the piriform aperture accompanying maxillary atrophy and stabilizes the foundation of the nose, thereby improving how the tip appears. However, this does not reconstruct the tip support itself; it is purely an auxiliary role.
Self-check the changes in your own nose
To objectively evaluate the changes in your own nose, try checking the following points. We recommend periodically taking photos under the same conditions (same place, same lighting, same angle) and comparing them.
- Change in the nasolabial angle: In a profile photo, confirm the angle formed by the columella and the upper lip. This angle has individual differences in the ideal range depending on sex and bone structure; for example, 90–100 degrees is merely one guideline. If this angle is clearly more acute compared with a previous photo, it may be a sign that the tip is tending to droop, but whether treatment is needed is not decided by the angle alone.
- The roundness and contour of the tip: Confirm whether the highest point of the tip has become unclear compared with before and whether it has come to look round and large overall.
- How the nostrils appear when viewed from the front: When the tip drops, the nostrils can become harder to see when viewed from the front.
- Comparison with past photos: By comparing with old photos taken at the same angle and same lighting, it becomes easier to confirm objective changes in the height and contour of the tip.
[Signs you should consider a visit]If accompanied by sudden shape changes, pain, redness, swelling, difficulty breathing, and the like, consult a specialist early. Especially if there is a past surgical history, problems such as infection or graft material may also be considered.
About cases where past rhinoplasty is the cause
The long-term impact brought by changes in the support structure
Consultations such as "I had nose surgery several years ago, but recently I feel the tip has become round and drooping" are actually often heard in consultations.
Past rhinoplasty itself can sometimes become the cause of later tip droop. Among the surgical techniques to raise or thin the nose, there are some that excise or suture the existing cartilage.
Depending on the technique, it may affect the stability of the mechanism that supports the tip, and over time the height (projection) and angle (rotation) of the tip may change.
About postoperative changes
In the study by Adams et al. (1999), it is reported that, regardless of the intent of the surgery, changes in the projection of the tip (the height/projection from the nasal root or the plane of the face to the tip) can occur postoperatively.
Human skin, when undermined (the operation of peeling) from bone or cartilage, tends to form a scar in the healing process and contract. Due to this scar contraction or repositioning of the soft tissue, morphological changes can occur postoperatively. In particular, when a support structure of sufficient strength to resist the contractile force of the skin has not been reconstructed, the form immediately after surgery is not maintained, and tip droop or deformity can occur over several months to several years. How this change manifests is also affected by the original skin thickness and individual healing tendencies.
About the "support structure" that supports the nasal tip
The important anatomical mechanism that supports the nasal tip
The tip can maintain a high position because the internal "support structure" works like the framework of a tent. Mainly, the following tissues bear this role.
1. The attachment of the lateral crus (the lateral part of the lower lateral cartilage) to the piriform aperture
2. The scroll ligament (the ligament connecting the cartilages on the side of the nose)
3. The interdomal ligament (the ligament connecting the apexes of the left and right alar cartilages)
4. The attachment of the medial crus (the cartilage of the columella) to the septum
These pull on each other like the props or ropes of a tent, maintaining the height of the tip.
About the role of the ligaments
In the study by Adams et al. (1999), it is shown that the open approach, which incises the columella, accompanies skin undermining and ligament changes compared with the closed approach, and therefore may invite changes in projection.
In addition, it is reported that the support force of the tip changes in relation to ligaments that are cut during flap elevation (the operation of lifting the skin) at the time of surgery.
Through anatomical studies as well, the importance of the various ligaments has become clear, and preservation or repair of the ligaments is recommended. How these support structures, especially the ligament tissue, are preserved, or appropriately reconstructed, can sometimes be important in maintaining long-term morphology.
About the approach to a dropped nasal tip
About cartilage grafting that reconstructs from the foundation
As one approach to a tip that has dropped due to aging or past surgery, there is a method of fundamentally reconstructing the changed support structure with firm tissue.
As an approach to restore the lost support force of ligaments or cartilage, there is a method of re-establishing a physical strut using the patient's own cartilage (auricular cartilage, costal cartilage, septal cartilage, etc.). Constructing a firm nasal framework is considered important.
Supporting the tip with an approach to the piriform aperture
As representative techniques, there are the "septal extension surgery (septal extension graft)," which grafts graft cartilage onto the septal cartilage to extend the tip forward and downward, and the "columellar strut graft," which erects a strut between the left and right columella. By combining these, a firm framework that supports the tip is constructed, and the projection (height) and rotation (angle) are adjusted.
By this, the construction of a "new foundation" that can cope with the strong contractile force of the skin is aimed at. Furthermore, against bone-structure atrophy due to aging, an approach to supplement the volume of the base of the nose is also important.
In addition, if the area around the piriform aperture is depressed due to bone-structure atrophy from aging, an approach of grafting cartilage or artificial material into that part to reinforce the foundation is also sometimes used together. By this, the balance of the whole nose is arranged, and an effect in which the tip appears relatively higher can be expected. However, these surgical approaches carry risks such as postoperative scarring, infection, and resorption/deformity of the grafted cartilage. In addition, the possibility of a discrepancy with the expected result, and rarely, an effect on breathing function, and so on, must also be considered. Which treatment is optimal is carefully judged according to each person's anatomical features and skin condition, so sufficient consultation with a physician is indispensable.
So you don't regret rhinoplasty. Criteria for choosing a clinic
Choose a physician who has anatomical knowledge, not just techniques
One of the important points in choosing a clinic is the point of "whether the physician deeply understands the anatomical support structure of the nose and has the skill to preserve or reconstruct it."
It has been pointed out that, depending on the technique, when the preservation or reconstruction of the support structure is insufficient, the tip may drop again in the months to years after surgery.
Therefore, it is desirable to consult a physician who deeply understands the complex anatomical structure of the nose and can propose a surgical plan with an eye on long-term stability.
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Summary of this article
- The height of the nasal tip can change due to multiple factors, such as the decline in cartilage elasticity and bone-structure atrophy accompanying aging.
- Past rhinoplasty surgery can affect the support structure and become one cause of long-term morphological change.
- To maintain or reconstruct the shape of the tip over the long term, an approach based on an understanding of the "support structure," including ligaments and cartilage, is the key.
- Treatments include methods such as reconstructing the support structure through cartilage grafting and reinforcing the bone-structure foundation, and a choice according to each person's condition is necessary.
If you have worries about the shape of the tip or anxiety about changes after surgery you received in the past, please consider receiving a consultation at a specialized clinic. Through an examination by a physician, you can learn the options suited to your condition.
References
- Kim J, Song J, Park S, et al. Tip Extension Suture. Plastic and Reconstructive Surgery. 2014 (DOI)
- Adams W, Rohrich R, Hollier L, et al. Anatomic Basis and Clinical Implications for Nasal Tip Support in Open versus Closed Rhinoplasty. Plastic and Reconstructive Surgery. 1999 (DOI)
- Daniel R, Palhazi P, Gerbault O, et al. Rhinoplasty: The Lateral Crura–Alar Ring. Aesthetic Surgery Journal. 2014 (DOI)
The author of this article
Hiromitsu Nakamura Physician
Zetith Beauty Clinic Ginza / Osaka / Fukuoka
He has a track record of research presentations at domestic and international conferences in Japan and is also involved in technical guidance and education across the entire Zetith Beauty Clinic. Specializing in precise rhinoplasty based on anatomical grounds, he pursues natural results tailored to each individual's bone structure and tissue.