A drop in collagen and elastin production; a loss of bone mass; a decrease in facial volume. These changes are part of getting older, and you often notice them as laxity and crepiness around the eyes, a flattening of the midface and cheeks, or jowling of the jawline. One facial feature you may not have realized is also impacted? The nose.
With age, the nose begins to droop as collagen is lost and the supporting structure diminishes. And, unfortunately, even a nose job from your teens or early twenties isn’t immune to effects of Father Time and Mother Nature. So, while secondary (or even primary) rhinoplasty surgery may be the answer for some, other nose shaping solutions can help lift the sniffer back to where it belongs. Here’s what you need to know.
The Causes of a Droopy Nose
Sometimes called a floppy nose or downward-pointing nose, there are a handful of reasons why we start to see the front of the nose – more specifically, the tip – fall forward with age. Not everyone experiences drooping to the same degree. But, for those who find it noticable, it can be reason enough to want to understand why it’s happening and what to do about it.
Both guys and gals are equally susceptible to developing a droopy nose over time. Men generally begin with a more acute angle than women and the muscles acting on the tip are a bit stronger, says Andrew Frankel, MD, a double board certified facial plastic and reconstructive surgeon in Beverly Hills. Furthermore, hormones are partially to blame. Females lose estrogen with age, making the skin and tissue thinner and less supportive. Men, meanwhile, often see sagging as a result of nasal injuries that were never corrected.
Unless it’s impacting your ability to breathe, a droopy nose isn’t a cause for medical concern. But that doesn’t mean it doesn’t pose an aesthetic one. Across the board, these are the main reasons why your once perky nose may be looking a little longer and less angular these days:
1. A Weak Internal Structure
As we age, it’s typical for the cartilage and ligaments inside the nose to weaken, which creates a droopy tip, says Farhad Ardesh, MD, a double board certified facial plastic and reconstructive surgeon in Beverly Hills. “The nasal septum is a wall consisting of cartilage and bone that divides the inside of the nose into the right and left sides,” he explains. “It is the foundation and support beam that holds up the tip of the nose.” If the front part of the septum is crooked, then the tip lacks proper support. “As the unsupported nasal tip droops down, it pulls the skin over the bridge of the nose down over the bones,” he shares. This downward pull of skin creates the appearance of a hump or makes pre-existing humps seem more pronounced.
Cartilage changes can also cause the midportion of the nose to begin to look pinched or asymmetric. In addition, as the ribbons of cartilage that make up the tip of the nose relax outward and downward, the nose may look rounder, wider, and ‘droopier’ than it used to, says Dara Liotta, MD, a double board certified facial plastic and reconstructive surgeon in New York City. Changes to the blueprint of the cartilage can also give way to difficulties in breathing.
With lost tissue support, the stiffness imparted by these tissues also diminishes, causing the nose to ‘stretch’ to a degree, says Dr. Frankel. “Given that the forces acting on the nasal tip when one speaks and smiles are often directed downwards, the tip will tend to fall over time,” he explains.
If your parents or grandparents sport a flaccid nose, there’s a pretty good chance you will, too. Dr. Ardesh says that those genetically inclined to experience drooping should consider surgery – particular if they have cosmetic or breathing concerns. Ethnicity can also influence where and how the nasal tip sits. Some nationalities generally have a weak or small amount of cartilage that affects overall support. Trauma and previous rhinoplasty or other nasal surgery also affect how the nose ages (more on that below).
3. A Previous Rhinoplasty with Poor Tip Support
Droopy tips can occur if past nasal surgeries did not provide adequate cartilage grafting to support the end of the nose. “Rhinoplasties can contribute to either more or less drooping depending on the technique utilized by the surgeon,” says Jay Calvert, MD, a board certified plastic and reconstructive surgeon in Beverly Hills. For example, open rhinoplasty techniques use cartilage grafts to add support, whereas a closed rhinoplasty approach does not employ these grafts. This can lead to more pronounced tip sagging down the line.
4. The Natural Aging Process
The nose is not impervious to age-related shifts and alterations in the body. Changes in the bones, cartilage, fat, ligaments, and skin all contribute to the way our nose ages, says Mary Lynn Moran, MD, a double board certified facial plastic and reconstructive surgeon in Franklin, TN, and past president of the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS). “The facial bones begin to resorb, thus providing less of a foundation for the nose and the ligaments loosen, which can cause the tip to become less defined and droop,” she shares.
There are also changes to the skin (it thins) and fat (it often resorbs), giving way to a skeletonized appearance. The ligaments that support the nose weaken and collagen fibers shorten, which causes less robust soft tissue support, Dr. Calvert explains. “All of these factors result in the descent of the tip of the nose,” he says.
The Effect on Facial Balance
Facial harmony is all about proportion, which means changes to one feature (i.e. the nose) can impact the structure and aesthetic of the entire face. Here’s a few of the ways it can manifest:
- The Lower Face: As the nose becomes longer or the tip more bulbous, the distance between the lips and the base of the nose can appear shorter. A droopy tip makes the upper lip look longer (not necessarily fuller), which ages the lower face since the distance between the nose and mouth shortens.
- The Eyes: The nose and eyes are close to one another, and that relationship changes markedly with age. “As the shape of the eye sockets deepens, the nasal bridge can look more prominent and the eyes appear closer together,” Dr. Frankel explains. “Often, lowering the height of the nasal dorsum will have an overall rejuvenating effect on the face.”
- The Whole Face: As the tip begins to fall forward, it’s common for the nostrils to start to widen, which can throw the entire balance of the face off-kilter. Furthermore, when the tip droops, it can lead to the appearance of a more prominent nasal dorsum (the bone and cartilage ‘hump’ of the nose), says Adam Kolker, MD, a board certified plastic and reconstructive surgeon in NYC. This might draw new attention to your sniffer.
At this point, you might be wondering if there is anything you can do to slow down or stop the hands of time. While there is seemingly an endless stream of preventive treatments on the market today, the nose is a little more complicated.
Laser treatments may be able to treat the skin on and around the nose, Dr. Calvert notes. And, for some, he says injecting fillers in the columella may also help support the tip. Those with a naturally acute angle between their lip and nasal tip can prevent it from progressing by having rhinoplasty to change the relationship between the septum and tip cartilages. “Rhinoplasty surgery is only indicated when an individual desires improvement of changes that can already be seen, not as a proactive measure,” Dr. Kolker clarifies.
It should be noted that, even if you had rhinoplasty as a teenager or young adult, there’s no guarantee that the previous surgery will make the nose resistant to drooping, especially the tip. “It depends upon the technique used and whether the surgeon cut cartilage away to achieve the desired cosmetic result (‘reductive rhinoplasty’) or if the surgeon added structure to build the new shape of the nose in an architectural way (‘structural rhinoplasty’),” Dr. Liotta says. “Cutting away the cartilage in a primary rhinoplasty can make these changes worse and can cause asymmetry and more drooping with time, while building a new structure can help keep the underlying structure of the nose strong and prevent, or limit, drooping.”
Other than that, there isn’t much to do preemptively. Sure, healthy lifestyle choices are always the way to go since they can help minimize a breakdown of collagen and elastin, but, unfortunately, chromosomes and gravity always prevail.
How to Correct a Drooping Nose
If a droopy nose is what you focus on every time you look in the mirror, there are ways to fix it — and they’re not all surgical. But, of course, surgery is usually the most transformative option since it provides the longest lasting improvement and the most structural support. “All noses are dynamic and will change over time,” Dr. Kolker says. “While many rhinoplasty techniques include maneuvers to support and stabilize the nasal tip – including a variety of cartilage graft techniques – these noses are nevertheless subject to the same laws of genetics and physics that affect all noses.” With that in mind, below are the surgical and non-surgical treatment options for addressing a drooping nose:
1. With Surgery
Rhinoplasty is the most traditional way of correcting major nasal issues. If a crooked septum is causing your droopy nose, Dr. Ardesh says a septoplasty can be performed in tandem. But, as we’ve mentioned, technique matters. “Rhinoplasty and septoplasty surgeries can create a droopy nose tip years after surgery,” he cautions. During a septorhinoplasty, your plastic surgeon will remove portions of the septal cartilage, but not all of it. “Then, we carve the cartilage into support beams called grafts that we place to enhance the structural integrity of the nose,” he shares.
At her practice, Dr. Liotta is seeing many patients in their forties and fifties coming in for what she calls ‘nasal rejuvenation’ surgery. “These patients don’t want to change their look,” she says. “They just want to get back to the more refined and airbrushed look that they had when they were younger.” Where is this renaissance of rejuvenation rhinoplasty coming from? “I think this stems from the Zoom culture — people staring at themselves in ways they hadn’t previously,” she shares. “These aren’t the patients obsessed with their selfies and striving for perfection.” As such, Dr. Liotta says her nasal rejuvenation surgery also optimizes breathing by restoring structure and support, a big plus for those that suffer from poor breathing that may result with age.
2. With Fillers
There are also non-surgical options to consider as long as you know they will not provide the same result as a surgical fix. “Liquid rhinoplasties use hyaluronic acid fillers, such as Restylane® or Juvéderm®, under the skin of the nose, which may help enhance the side views of the tip and nasal bridge,” Dr. Ardesh says. They can also help push the tip of the nose up, so it appears as if it’s not falling.
Yet, the results of liquid rhinoplasty are temporary (think: six to 12 months), and, if there’s too much blunt definition at the tip, it can further weigh down the nose. “Liquid rhinoplasties performed in patients who do not have adequate support to the lower half of the nose can result in poor appearance and even compromised breathing,” he warns. In addition, using fillers to improve a descending tip can create more of an obtuse angle between the top of the nose and lip to help soften the degree of flaccidity.
3. With Neuromodulators
Injecting neuromodulators (read: Botox®, Dysport®, Jeuveau®, and Xeomin®) can, however briefly, help to lift the tip. Placing any one of these products into the small muscle under the nose (i.e. depressor septi nasi) can help lessen the extent of drooping when smiling. It’s not a permanent fix (it lasts the standard three to four months you can expect from all neurotoxin injections), but, for those bothered by their tip and not willing to undergo surgery, the subtle and short-lived change can be just what the doctor ordered. Strategically placed neuromodulator injections can also be used to smooth bunny lines around the nose.
4. With Threads
There is no denying that thread lifts are having a moment, and the nose can also benefit from their minimally invasive lifting powers. In some patients, threads can ever-so-slightly pick up the nasal tip. But, unlike other more predictable and lasting measures, Dr. Ardesh cautions that thread lift results are not very effective and only last a few months before the tip of the nose falls back down. At best, it’s a short-lived solution.
If you feel like you woke up one morning with a different nose, you are not alone. The facial feature is not immune from the effects of gravity and aging, which, for many, manifest as a drooping tip and the elongation of a once perky and proportional sniffer. If you are unhappy with the way these changes are impacting you aesthetically or functionally, there are both surgical and non-surgical treatment options.
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