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Aging Nose Injectable Rhinoplasty and Surgical Rhinoplasty

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In my last podcast, I talked about relative proportions for rhinoplasty, and it got me talking a little bit about aging nose and aging rhinoplasty. And I thought I would do a dedicated podcast on that topic. The aging knows what an anatomically occurs is several things. One is that the outer skin envelope starts to become thinner. And then the bony elements, the nose becomes more visible or the underlying cartilage becomes more visible. That is one component. The other component is the nose tip, people say it grows. It actually doesn’t theoretically, or actually in reality grow what’s happening is that there is this thing called a scroll. It’s the junction between the lower third of the nose and the middle third of the nose. Those two pieces of cartilage called the lower lateral and upper lateral cartilages become weaker. And that scroll begins to separate so that the tip where the lower lateral cartilage starts to dive downwards and fall downwards so that the nose looks lengthened.

I think probably the most obvious example of that is what, which his nose would be. Cause when you see a witch that kind of nose, you think of that person being older, or Leonardo DaVinci, for example, when you see that, some of the drawings of the older gentlemen with a nose hanging down, you associate that with an aging nose. It definitely does not look youthful. So in this podcast, I’m going to be talking about two ways to rejuvenate the nose one nonsurgically and one surgically, and why those elements and ways to do it can make a difference for someone who’s a good candidate. So the nonsurgical method of rhinoplasty is obviously just a filler. And so if you think about if the listen to the last podcast on proportions for rhinoplasty, but in that podcast, I basically said, if you raise the bridge, you can oftentimes make the tip look smaller.

So if you think about this, if the tip becomes proportionately bigger, as someone gets older, if you raise the bridge, you do two things, you cover the, the bone that’s exposed, maybe a hump that’s exposed that can also look like aging. You can cover that by filling above it in the area called the radix, you can expand the soft tissue envelope so that the skin, you don’t see the bone underneath, which makes it look more youthful. And you can also make the tip look smaller because when you raise the bridge a little bit, the tip and proportion looks smaller. So that is a very common strategy that I do for injectable rhinoplasty is to inject the bridge of the nose with some fillers, of course, using a safe technique, using a micro cannula to do that and it just makes the whole face look younger.

And a couple of times this last week, I thought, why didn’t I, I forgot to inject this patient’s nose. I had injected her face the whole time, and I forgot the nose. And once you do that, it just makes the whole face look better. It’s amazingly small amount of product. I can oftentimes do it, and a quarter to half a syringe and sometimes even less. And so the allocation of product is so minimal and it makes such a big difference. What’s interesting is for me, oftentimes I prefer to do injectable rhinoplasty in someone older, because I’m already doing their whole face and then I just add a little bit in the noses no cost extra. For younger patients, they don’t really need in the face, maybe they want the lips done. So then you have to dedicate a syringe for the nose. In a relative sense, it’s more costly, and also over the lifetime, I have to keep on dedicating for the nose. I always like to use the nose as a bonus when I do injectable rhinoplasty, rather than as a stand-alone, but ultimately doesn’t really matter. I mean if you really are focused on the nose, you don’t want to do a surgical rhinoplasty than injectable rhinoplasty could be suitable for you, for sure at any age.

The surgical rhinoplasties, I perform quite a few aging nose rhinoplasties. One category would be a rhinophyma reduction, which is the nose that gets expanded and large because the oil glands get bigger. It’s an end stage type of acne rosacea, and that’s that you shave down the scan, which is a very unique thing. You can look at some before and afters on my website that typically occurs more in males and typically in fair skin males. Then if you think about the witches nose, the witches nose is a classic sign of aging. And so if the nose tip has been a dependent and hanging, you just raise the nose bridge a little bit, the person looks younger. If there’s a hump, you just take the hump down a little bit, and the person looks more youthful.

For men, the other thing to consider is that as they get older, sometimes their self-image becomes more static and less mutable, so that if you take a hump down and changes a nasal tip, you know, after the age of 45, it’s really for heterosexual men, that may be a site negative for them because they probably are used to their nose. Whereas it’s interesting with women, I can do a rhinoplasty on a 65, 70 year old woman. And the woman feels as if that new nose is something they’ve had all their life. Now, of course, these are, you know, differences that may not be a hundred percent applicable for every single individual, but these are just basic psychological principles that are there as well. So, um, aging rhinoplasty is something that I do quite a few of both injectable as well as surgical. And I just want to talk to about some of the principles of what I’m trying to achieve and why it may be beneficial for you.