0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Research Letters |

The Effect of Rhinoplasty on Perceived Age FREE

Ali Sepehr, MD; Nitin Chauhan, MD; Ashlin Alexander, MD; Peter A. Adamson, MD
[+] Author Affiliations

Author Affiliations: Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.


Arch Facial Plast Surg. 2012;14(1):68-70. doi:10.1001/archfacial.2011.1233.
Text Size: A A A
Published online

The aging nose tends to undergo characteristic changes. With increasing age, there is weakening of the major and minor nasal tip support mechanisms leading to nasal tip deprojection and development of the so-called dorsal pseudohump. Furthermore, ligamentous laxity leads to lobular descent, causing nasal lengthening and counterrotation.1 Posterior-superior remodeling of the premaxillary bony skeleton, which acts as the platform for the nasal base (ie, midface retrusion), also contributes to a more acute nasolabial angle (NLA).24

The goal of rhinoplasty is to effect changes that result in a nose that is more harmonious and balanced with overall facial proportions. These changes often include correction of nasal attributes that are also characteristic of the senile nose. The philosophy of Stupak and Johnson1 is to include rhinoplasty in the armamentarium of procedures that rejuvenate the face; they argue that, in selected patients, this approach produces a more harmonious result. Similarly, Cochran et al5 discuss their technique of restorative rhinoplasty, in contradistinction to transformative rhinoplasty. However, to date, the rejuvenating properties of rhinoplasty have yet to be proven or quantified. Therefore, the aim of this study is to determine if rhinoplasty, in addition to beautifying the face, also rejuvenates it. Another aim of this study is to determine if patient age, hump reduction, and nasal tip rotation are independently predictive of greater rejuvenation obtained with rhinoplasty.

The study took place at a private facial plastic surgery practice in a major metropolitan area with a focus on rhinoplasty. The medical charts of the last 53 consecutive rhinoplasty patients (of the senior author, P.A.A.) with preoperative pictures and 1-year postoperative pictures were retrospectively reviewed. The data gathered included age and sex. The preoperative frontal and right lateral images were paired. The postoperative frontal and right lateral images were also paired. Of note, as a routine practice of the senior author, the pictures were standardized through the use of the same camera, room lighting, and distance, and there were no changes made in the study period. Fifty laypersons (observers) were asked to evaluate and rate the age of the patient appearing in the frontal and right lateral images. The ratings of the preoperative and postoperative images of a given patient by an observer took place on 2 separate days, at least 1 month apart: half of the observers (25) evaluated the preoperative images first and then the postoperative images 1 month later; the other half of the observers (25) evaluated the postoperative images first and then the preoperative images 1 month later. The average difference in age between the before and after photographs was calculated for each patient based on the perceptions of the 50 observers. The variables in this study were patient age, presence or absence of a dorsal hump, NLA, and rhinoplasty. The outcome measure was change in perceived age, referred to as “years lost” and defined as ageafter − agebefore − 1. Ageafter was assessed at 1 year after surgery.

The preoperative and postoperative right lateral images were reviewed for the presence or absence of a dorsal hump. The NLA was measured on the preoperative and postoperative right lateral images using Adobe Photoshop (Adobe Systems Inc, San Jose, California). These determinations and measurements were performed by the same author (A.S.) on the preoperative and postoperative images.

The statistical significance of the results was evaluated by the Fisher exact test, Wilcoxon signed rank test, and linear regression analysis (to eliminate any possible confounding interactions of the variables).

The demographic information was as follows: the patients' mean age was 35 years (range, 15-61 years). Forty-one (77%) were female, and 12 (22%) were male. On average, the patients looked 1.5 years younger after rhinoplasty (P < .001).

Subgroup analysis was performed to determine if dorsal hump reduction, nasal tip rotation, or age had any effect on the number of years lost after rhinoplasty. The effect of dorsal hump reduction on years lost was evaluated. Nineteen patients never had a dorsal hump. Thirty-two patients underwent a dorsal hump reduction. Patients who underwent hump reduction looked, on average, 1.6 years younger following surgery, whereas patients who never had a dorsal hump looked on average 1.1 years younger (P = .05).

The effect of the patient's actual age on years lost was evaluated. Figure 1 demonstrates that while almost all patients looked younger following surgery, older patients tended to enjoy a greater degree of rejuvenation, with more years lost compared with the younger cohort. Three age groups (<20 years, 20-40 years, and >40 years) were compared, and there was no statistically significant difference in the years lost among groups (P = .15).

Place holder to copy figure label and caption
Graphic Jump Location

Figure 1. The relationship between years lost and patient age at surgery. The horizontal line shows no change in perceived age from before to after surgery.

Change in the NLA was defined as NLApostop − NLApreop, where postop and preop indicate postoperative and preoperative, respectively. Therefore, a positive change in the NLA (increased NLA) reflects nasal tip rotation. Eight patients had nasal tip rotation greater than 10°. These patients looked on average 2.0 years younger. The 45 patients who had nasal tip rotation of 10° or less looked 1.3 years younger (P = .04).

The greatest years lost was seen in the subgroup of 6 patients who underwent dorsal hump reduction and more than 10° tip rotation (−2.14). This difference from the other subgroups was statistically significant (Figure 2). The subgroup of 2 patients who did not undergo dorsal hump reduction but had more than 10° nasal tip rotation looked 1.6 years younger. The subgroup of 26 patients who underwent dorsal hump reduction but had nasal tip rotation of 10° or less looked 1.5 years younger. The subgroup of 17 patients who did not undergo dorsal hump reduction and had nasal tip rotation of 10° or less looked 1.1 years younger.

Place holder to copy figure label and caption
Graphic Jump Location

Figure 2. Comparison of years lost between the 4 subgroup combinations of presence or absence of dorsal hump reduction and nasal tip rotation of more than 10° or 10° or less. NLA indicates nasolabial angle. The error bars indicate standard deviations.

Patients who undergo rhinoplasty can expect, on average, a 1.5-year decrease in apparent age. Subgroup analysis demonstrated that patients who underwent dorsal hump reduction had more years lost than patients who never had a dorsal hump (1.6 vs 1.1; P = .05). Therefore, dorsal hump reduction is an important predictor of increased years lost after rhinoplasty and a greater rejuvenation effect.

The variable of change in the NLA was evaluated as a predictor of a greater decrease in apparent age. The cohort was divided into 2 subgroups: those undergoing nasal tip rotation of more than 10°, and those undergoing nasal tip rotation of 10° or less. Subgroup analysis demonstrated that patients who had a change of NLA of more than 10° had more years lost than patients who had a change of NLA of 10° or less (2.0 vs 1.3; P = .04). Therefore, a change of NLA greater than 10° is an important predictor of increased years lost after rhinoplasty and a greater rejuvenation effect.

Subgroup analysis demonstrated that patients who had a combination of dorsal hump reduction and nasal tip rotation greater than 10° together had more years lost than either procedure alone or neither procedure. Therefore, a combination of both variables together is an important predictor of even more years lost after rhinoplasty and an even greater rejuvenation effect.

To our knowledge, this is the first study to demonstrate a statistically significant decrease in apparent age after rhinoplasty. This decrease in apparent age is an extra positive benefit of rhinoplasty, in addition to an increase in the harmony of facial features and the improvement of overall facial aesthetics. Thus, this finding can pleasantly surprise patients presenting for rhinoplasty. Regardless of age, those patients with dorsal humps and/or with acute NLAs can expect even stronger rejuvenating effects of rhinoplasty. The rejuvenating effect of rhinoplasty can now objectively be listed as one of the benefits of undergoing this procedure.

Correspondence: Dr Sepehr, Department of Otolaryngology–Head and Neck Surgery, University of Toronto, 150 Bloor Ste W, Ste M110, Toronto, Ontario M5S 2X9, Canada (asepehr@ucla.edu).

Author Contributions: Dr Sepehr had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Sepehr, Chauhan, Alexander, and Adamson. Acquisition of data: Sepehr, Chauhan, and Alexander. Analysis and interpretation of data: Chauhan. Drafting of the manuscript: Sepehr, Chauhan, and Alexander. Critical revision of the manuscript for important intellectual content: Sepehr, Chauhan, Alexander, and Adamson. Statistical analysis: Chauhan and Alexander. Administrative, technical, and material support: Adamson. Study supervision: Alexander and Adamson.

Financial Disclosure: None reported.

Stupak HD, Johnson CM Jr. Rhinoplasty for the aging nose.  Ear Nose Throat J. 2006;85(3):154-155
PubMed
Pessa JE, Desvigne LD, Zadoo VP. The effect of skeletal remodeling on the nasal profile: considerations for rhinoplasty in the older patient.  Aesthetic Plast Surg. 1999;23(4):239-242
PubMed   |  Link to Article
Moody M, Ross AT. Rhinoplasty in the aging patient.  Facial Plast Surg. 2006;22(2):112-119
PubMed   |  Link to Article
Romo T III, Soliemanzadeh P, Litner JA, Sclafani AP. Rhinoplasty in the aging nose.  Facial Plast Surg. 2003;19(4):309-315
PubMed   |  Link to Article
Cochran CS, Ducic Y, DeFatta RJ. Restorative rhinoplasty in the aging patient.  Laryngoscope. 2007;117(5):803-807
PubMed   |  Link to Article

Figures

Place holder to copy figure label and caption
Graphic Jump Location

Figure 1. The relationship between years lost and patient age at surgery. The horizontal line shows no change in perceived age from before to after surgery.

Place holder to copy figure label and caption
Graphic Jump Location

Figure 2. Comparison of years lost between the 4 subgroup combinations of presence or absence of dorsal hump reduction and nasal tip rotation of more than 10° or 10° or less. NLA indicates nasolabial angle. The error bars indicate standard deviations.

Tables

References

Stupak HD, Johnson CM Jr. Rhinoplasty for the aging nose.  Ear Nose Throat J. 2006;85(3):154-155
PubMed
Pessa JE, Desvigne LD, Zadoo VP. The effect of skeletal remodeling on the nasal profile: considerations for rhinoplasty in the older patient.  Aesthetic Plast Surg. 1999;23(4):239-242
PubMed   |  Link to Article
Moody M, Ross AT. Rhinoplasty in the aging patient.  Facial Plast Surg. 2006;22(2):112-119
PubMed   |  Link to Article
Romo T III, Soliemanzadeh P, Litner JA, Sclafani AP. Rhinoplasty in the aging nose.  Facial Plast Surg. 2003;19(4):309-315
PubMed   |  Link to Article
Cochran CS, Ducic Y, DeFatta RJ. Restorative rhinoplasty in the aging patient.  Laryngoscope. 2007;117(5):803-807
PubMed   |  Link to Article

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
CME Related by Topic
PubMed Articles