Rhinoplasty in the Older Adult.

BACKGROUND: Rhinoplasty in older adults requires unique consideration of the ageing nose. The purpose of this study was to systematically review the literature pertaining to rhinoplasty in this population, review the senior author's experience, and describe techniques aimed at addressing such features.

OBJECTIVES: We hypothesized consistent age-related nasal dysmorphology is described in the literature and standard rhinoplasty techniques may effectively address these changes. Furthermore, we hypothesized rhinoplasty is more commonly performed for post traumatic 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 study criteria. Manifestations of the ageing nose included soft tissue atrophy, bony fragility and resorption, tip ptosis, internal and external valve collapse, and worsening dorsal hump. 27 patients were included in our institutional review. Primary indication for rhinoplasty was post-traumatic 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.