The nose is a complex three-dimensional structure composed of a bony vault in the upper third and a flexible framework of cartilage and soft tissue forming the lower two-thirds. Unlike many other parts of the skeleton, the nose continues to change after adolescence, leading to noticeable alterations in its appearance over time. Its external shape is defined by the nasal bones, the septum, and the paired upper and lower lateral cartilages, all covered by a skin-soft tissue envelope. Changes in the size, projection, or angle of the nose can be attributed to various factors, including natural processes, physical incidents, or underlying health issues.
Changes Related to Natural Growth and Aging
The nasal structure develops significantly during youth, with the bony component typically reaching adult size by the late teenage years. However, the cartilaginous framework and surrounding soft tissues continue to change subtly throughout life. This ongoing process is largely driven by gravity and the biological decline of supporting tissues. The cartilage, particularly the lower lateral cartilages that shape the nasal tip, gradually loses elasticity over decades.
This weakening of the structural support system allows the nasal tip to rotate downward, a phenomenon known as ptosis, making the nose appear longer. Simultaneously, the skin loses elasticity due to the breakdown of collagen and elastin fibers. The combination of droopy cartilage and less resilient skin contributes to the perception that the nose is widening or becoming more bulbous with age. The continuous change in soft tissue and cartilage integrity creates the illusion of a perpetually enlarging nose.
Structural Alterations from Injury and Trauma
External physical force can instantly alter the shape of the nose, resulting in immediate deviation or collapse. A fracture of the nasal bones or the central septal cartilage directly compromises the structural integrity of the nasal bridge. Direct trauma can also cause a septal hematoma, which is a collection of blood between the septal cartilage and its protective lining.
If this hematoma is not promptly drained, the cartilage is deprived of its blood supply, leading to necrosis, or tissue death, within days. The subsequent loss of central septal support can cause the nasal bridge to sink inward, resulting in a saddle nose deformity. The body’s long-term response to injury involves the formation of internal scar tissue, or fibrosis, which can subtly contract and alter the nasal contour months or years after the initial incident.
Medical Conditions and Chronic Inflammation
Changes in nasal shape can be a sign of underlying health conditions that cause chronic inflammation or tissue overgrowth. One such condition is rhinophyma, a severe subtype of rosacea characterized by progressive overgrowth of sebaceous glands and connective tissue on the nose. This process leads to thickened, irregular skin texture and a bulbous, enlarged appearance, typically affecting the nasal tip. Rhinophyma is a dermatological disorder driven by chronic skin inflammation.
Long-standing inflammation from conditions like chronic rhinosinusitis, often accompanied by nasal polyps, can also contribute to external changes. Nasal polyps are non-cancerous growths that originate from the inflamed lining of the nose and sinuses. When these polyps become large, the chronic swelling and physical mass can exert outward pressure, potentially widening the nasal base or distorting the profile. Rare systemic conditions, such as acromegaly, cause the generalized overgrowth of soft tissues, including the nose, leading to a noticeable increase in size.
Post-Surgical and Cosmetic Changes
Intentional surgical alteration, most commonly rhinoplasty, initiates a controlled process of shape change that unfolds over an extended period. Although the immediate post-operative result is visible, the final contour requires the resolution of swelling and the maturation of internal scar tissue. The nasal tip retains swelling the longest due to its thicker skin and complex lymphatic drainage, often taking up to a full year to fully settle.
The final shape is established only after the internal healing process is complete and the scar tissue contracts around the newly positioned bone and cartilage. Late-stage changes can occur due to the failure or migration of cartilage grafts or implants used to refine the nasal structure. These complications can lead to a gradual loss of projection or the development of unexpected asymmetries.