The Aging Nose in Rhinoplasty for Facial Rejuvenation

Ries, William Russell; Rathfoot, Christopher

doi:10.1055/s-0028-1082410

Cited by 15 publications

(15 citation statements)

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“…The effects of aging on the infrastructure of the nose have been well delineated and previously reported. [1][2][3][4][5][6][7][8] To correct these changes, the tip must be rotated and reprojected. This can be accomplished with placement of a columellar strut and suture augmentation of the domes of the lower lateral cartilages.…”

Section: Structural and Functional Changesmentioning

confidence: 99%

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Rhinoplasty in the Aging Nose

Romo

Soliemanzadeh²,

Litner³

et al. 2003

Facial Plast Surg

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The aging nose presents a difficult challenge for the rhinoplastic surgeon. To best address the patient's wishes, the surgeon must possess a sound understanding of the atrophic changes associated with the aging nose, including tip ptosis, increased nasal bulbosity, a lengthened nasal appearance, and altered nasal airflow patterns. Surgical emphasis is placed on conservative structured reduction to address functional concerns. Overresection risks destabilizing the nasal tip and altering the patient's concrete self-image. This article outlines our approach to rhinoplasty in the aging nose with a special emphasis on the use of porous polyethylene alloimplants to provide added structural support.

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Section: Structural and Functional Changesmentioning

confidence: 99%

“…The loss of support of the caudal edges of the upper lateral cartilages leads to a decrease in the internal valve angle. 6 More significantly, ex-ternal valve collapse arises from buckling of the weakened lateral crura. 10 Dilator naris atrophy further reduces the patient's ability to support the nasal valve.…”

Section: Structural and Functional Changesmentioning

confidence: 99%

Rhinoplasty in the Aging Nose

Romo

Soliemanzadeh²,

Litner³

et al. 2003

Facial Plast Surg

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“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] Although the study for these nasal tip supporting structures have been performed by many researchers, the terms and definitions for these structures, except for dermocartilaginous ligament, have not been defined clearly. The structure between the upper and the lower lateral cartilages has been described as fibrous tissue or connection, 1,16,17 intercartilaginous ligament, 2 ligament-like arrangement, 4 or connective tissue. 7 The structure between the lateral crus and the pyriform aperture has been described as definite fibrous attachment 5 or ligamentous fibrous tissue.…”

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confidence: 99%

An Anatomic Study of Nasal Tip Supporting Structures

Han

Lee

Kim

et al. 2004

Annals of Plastic Surgery

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Successful rhinoplasty depends on nasal tip support and its influence on nasal tip projection. It is generally agreed that the components of nasal tip support include the attachment between the upper and lower lateral cartilages, the attachment between the lateral crus of the lower lateral cartilage and the pyriform aperture, the attachment between the paired domes of the lower lateral cartilages, and the medial crural attachment to the caudal septum. However, these structures are still not clearly determined, and there was no anatomic study of nasal tip supporting structures in Asia. The purpose of this study was to determine the nasal tip supporting structures and find out the differences in these structures between white and Asian people. Ten noses of fresh cadavers were investigated. Dissection was performed and the previously mentioned nasal tip supporting structures were observed and excised. Histologic examination was done with hematoxylin and eosin stain and Van Gieson elastin stain. Macroscopic study showed that there were dense fibrous tissue between the upper and lower lateral cartilages, dense fibrous tissue and sesamoid cartilages between the lateral crus and the pyriform aperture, loose connective tissue between the paired domes of lower lateral cartilages, and no identified specific tissue between the medial crus and the caudal septum. Microscopic investigation allowed a more detailed analysis of these structures. Between the upper and lower lateral cartilages, dense collagen fibers were running in one direction and anchoring firmly to each cartilage, which meets the histologic criteria of a ligament. Between the lateral crus and the pyriform aperture, there were intermingled collagen fibers and muscular fibers, which meets the histologic criteria of fibromuscular tissue. Between the paired domes of lower lateral cartilages, there were few fibers with abundant amorphous ground substances, which meets the histologic criteria of loose connective tissue. Based on our results, we recommend that the previously mentioned nasal tip supporting structures should be named intercartilaginous ligament, sesamoid fibromuscular tissue, and interdomal loose connective tissue, respectively. In addition, we consider that the loose connection between the domes of middle crura and the absence of an attachment of the medial crura to the caudal septum can be one of the reasons why the nasal tip of Asian people is broad and unprojected and the base is wide.

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“…Problematic, viscous postnasal drip plagues many older patients. 26,30 Many in their very senior years complain of suffering from catarrh.…”

Section: The Nosementioning

confidence: 99%

Aging Changes of the Periorbita, Cheeks, and Midface

Truswell

2013

Facial plast Surg

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The periorbita, cheeks, and midface are an area of complex facial form and function. There is a particular pleasing visual harmony of these regions in the youthful face. With time, the robust glow and fullness of youth fades and diminishes. The skin is the first component to show the passage of time as it dulls, wrinkles, and blemishes. This is followed by a slow loosening and sagging of soft tissues as they descend from their once-fixed points of the skeletal foundation. The smooth transitions between regions are separated and hollows and ridges appear. These processes continue throughout life and eventually are accompanied by the visible consequences of bone resorption. The faces age, and as the countenance of the human spring turns through summer into autumn, function follows form, and symptoms accompany signs. A thorough understanding of both youthful and elder anatomy as well as the stigmata of aging is prerequisite to perform rejuvenating procedures. This article discusses these changes and how the older anatomy becomes the new norm.

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The Aging Nose in Rhinoplasty for Facial Rejuvenation

Cited by 15 publications

References 0 publications

Rhinoplasty in the Aging Nose

Rhinoplasty in the Aging Nose

An Anatomic Study of Nasal Tip Supporting Structures

Aging Changes of the Periorbita, Cheeks, and Midface

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