The nose appears to change shape and size as a person ages, often creating the perception that it is getting larger. This belief is not unfounded, as the nose is one of the few facial features that continues to undergo noticeable, age-related changes throughout adulthood. While the underlying bone structure does not grow after adolescence, the surrounding tissues and cartilage are susceptible to the effects of time and gravity. Understanding these structural and soft tissue changes explains why the nose may look different later in life.
The Role of Cartilage and Gravity in Aging
The primary structural reason for the perceived enlargement is the gradual weakening of the nose’s cartilaginous framework. The lower two-thirds of the nose is composed of cartilage, a flexible tissue that provides support but is prone to change over decades. The nasal tip is supported by the lower lateral cartilages, which become weaker and less resilient with age.
This loss of structural integrity causes the nasal tip to rotate downward, a process known as ptosis. As the tip droops, the nose appears longer and more prominent, creating the illusion of increased size. This effect is compounded by the constant downward pull of gravity on the nasal soft tissues, contributing to the gradual elongation and widening of the lower nose. The fine fibrous bands connecting the nasal cartilages can also stretch, allowing the structure to descend subtly and further increasing the nasal height.
How Skin and Soft Tissue Contribute to Size
Beyond structural changes, the skin and soft tissues covering the nose also change in ways that add bulk and alter definition. The skin’s dermal layer loses elasticity and firmness due to the degradation of collagen and elastin fibers. This loss of support means the skin envelope is less able to tightly drape over the weakening cartilage, leading to a rounder, less defined appearance, especially at the tip.
A significant factor in the thickening of the nasal soft tissue is the enlargement of sebaceous glands, known as sebaceous hyperplasia. These oil-producing glands, which are numerous on the nose, can become hypertrophied. They present as small, yellowish bumps that add noticeable volume to the nasal surface. Chronic sun exposure exacerbates the breakdown of the collagen and elastin network, accelerating these visible changes and contributing to a rougher, thicker texture.
Medical Conditions That Cause Nasal Enlargement
A more rapid or significant change in nasal size can be caused by distinct medical conditions, which are less common than normal aging. One such condition is rhinophyma, a severe, progressive form of rosacea. This disorder is characterized by a significant, bulbous thickening of the nasal skin due to the overgrowth of sebaceous glands and connective tissue (sebaceous gland hyperplasia and dermal fibrosis).
Another systemic cause of progressive enlargement is acromegaly, a hormonal disorder resulting from an excess production of growth hormone (GH) and insulin-like growth factor-1 (IGF-1). The elevated hormone levels cause the slow, progressive growth of soft tissues, including the hands, feet, and the nose. Acromegaly leads to a noticeable broadening and thickening of the nose, often accompanied by other facial changes like a more prominent jawline.
Options for Addressing Appearance Concerns
For individuals bothered by the aesthetic changes of the aging nose, both non-surgical and surgical interventions are available.
Non-Surgical Options
Non-surgical options often involve the strategic use of dermal fillers, typically hyaluronic acid-based, to subtly reshape the nose. Fillers can camouflage a dorsal hump or add projection to a drooping tip, which can instantly make the nose appear more refined.
Surgical Correction
For a more definitive correction, surgical rhinoplasty remains the gold standard, particularly for addressing underlying structural issues. Surgery for the aging nose focuses on strengthening the weakened cartilages, often utilizing cartilage grafts to provide long-term support and lift the nasal tip (tip ptosis). A surgeon must carefully assess the quality of the nasal skin, as its reduced elasticity in older patients may limit the degree of refinement that can be safely achieved.