Structural and Functional Considerations in Rhinoplasty of the Aging Nose.

Abstract

To investigate the age-related anatomical, structural, and functional changes occurring in the human nose, and to evaluate the most effective surgical techniques utilized for structural rejuvenation and airway restoration in older patients. A comprehensive narrative literature review was conducted utilizing established scientific databases, including PubMed/Medline, Scopus, Web of Science, and Embase, covering articles published up to 2024. A structured search strategy was applied using keywords such as "aging nose," "rhinoplasty," "tip ptosis," "nasal valve collapse," and "nasal cartilages." Peer-reviewed clinical trials, anatomical evaluations, and authoritative surgical guidelines were included to synthesize the current evidence regarding morphological age-related changes and the efficacy of structural surgical techniques in older patients. The aging process fundamentally alters nasal morphology, primarily resulting in tip ptosis, dorsal pseudohump formation, and nasal valve collapse. These changes are driven by diminished skin elasticity, soft-tissue atrophy, and the weakening of cartilaginous suspensory ligaments. Because standard septoplasty often fails to resolve airway obstruction in older adults, robust structural modifications are required. Techniques utilizing septal extension grafts, columellar struts, and tongue-in-groove positioning successfully restore tip rotation and projection. Concurrently, the application of spreader grafts and alar strut grafts effectively counteracts dynamic internal and external nasal valve collapse, thereby significantly improving nasal airflow. The aging nose presents intertwined aesthetic and functional challenges caused by progressive tissue and cartilage degradation. Surgical management must move beyond simple resection and prioritize strong cartilaginous reinforcement and valve stabilization to achieve durable cosmetic outcomes and optimal functional breathing in older patients.