Why Your Nose Has Changed Shape

Pamela Christiani's middle-aged nose droop had her down, so she went on a fact-finding mission for solutions to her problematic proboscis.

By Pamela Christiani
noses

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How it all began

My recent nose job obsession is directly related to time — and my Aunt Rose. She's in her eighties now and has an indisputably large, bulbous sniffer. But it wasn't always that way: If you saw photos from her wedding when she was 24, her nose looked normal — and it was actually the nose I had for years.  

When I was in my twenties and thirties, I never thought about my nose (nor Aunt Rose's for that matter). Now, I’m over 40 and not particularly vain — I have no issue with the tiny lines around my eyes, nor the slight loss of volume to my cheeks and I embrace the "every age is beautiful" vibe… But I draw the line at a bigger nose, and mine is unquestionably larger than it was. Or, so it seems…

I needed some solid information on my options. I never watched Nip/Tuck or Botched, and YouTube just feels too massive and lowbrow for surgery queries. So, I reached out to two pros for clarity and direction: Dr. Alan Matarasso, the President of the American Society of Plastic Surgeons, is a board-certified plastic surgeon and clinical professor at Hofstra University/Northwell School of Medicine. He’s also the former President of the Rhinoplasty Society (a group of board-certified surgeons dedicated to the art and science of the rhinoplasty). Dr. Lara Devgan, another top-rated board-certified surgeon, was educated at Yale and Johns Hopkins and specializes in cosmetic and reconstructive surgery. She’s also the Chief Medical Officer @realself and shares a great deal of her knowledge (plus terrific before-and-afters) on social media, @laradevganmd. 

Why our noses get bigger with age

Both docs confirmed that I haven’t been imagining things.

“Even though the classic knowledge is that the nose doesn’t grow after the mid teen years, the skin on the nose can get fleshier and thicker or droop as we age. This can certainly give the appearance of a larger nose,” says Dr. Matarasso.  

Dr. Devgan adds, “It’s not that the nose is necessarily growing, but it may not be supported in the exact same way as when you were younger. Ligament structures can shift and cartilage can warp and change over time.”  

Dr. Devgan stresses that even the tiniest of shifts in the face, millimeters in size, can be visible. The bottom line: signs of aging can occur anywhere on the face, and the nose is no exception.

The options: surgical vs. non-surgical

My options are to go under the knife or the needle, basically. Non-surgical rhinoplasty is performed with hyaluronic acid fillers like Restylane or Juvederm. “I use filler as if it were a surgical cartilage graph, to change the way the soft tissue of the nose drapes over its support network,” explains Dr. Devgan.  “Fillers can provide optical illusions, so, for example, if someone is unhappy with a dorsal hump, fillers can pump up the radix (top of the nose, between the eyes) or the tip, to balance out the overall shape and proportion,” she adds.  

This element of “try-before-you-buy” is popular now, in Dr. Devgan’s practice. “Many of my patients just prefer a less invasive approach,” she says. That said, “surgical rhinoplasty is a more powerful procedure that allows you to do more. You can remove tissue, shave down bone, and adjust cartilage, maneuvers that are not possible with injectables,” she stresses. A non-surgical nose job can be done in minutes with virtually no downtime.

Surgical rhinoplasty “is typically an hour and a half, but the recovery is like a reverse pregnancy,” muses Dr. Matarasso. “You leave the surgery big and swelling, and months later, possibly up to or over a year, the work settles and is complete.” Now that’s news to me. I had no idea that the healing process can be that long.  Dr. Matarasso also confirms that nose jobs are for the most part permanent, and they should last a lifetime. “There are very few things that you can buy at age 16, or 49 for that matter, that don’t need touching up later.” Both doctors stress that this is not the time for bargain shopping. “It’s your face, your most prominent feature. And the nose is complex. Rhinoplasty is one of the more difficult cosmetic surgeries,” Dr. Matarasso says.

How to find a good nose surgeon

Thorough research on a surgeon’s expertise and experience is the next step. Dr. Matarasso suggests starting with the American Society of Plastic Surgeons. Their site, plasticsurgery.org, has a tab titled “Plastic Surgeon Match” which matches you with a board-certified surgeon in a particular area.

Dr. Devgan’s surgical rhinoplasty ranges from $15-$20K and her non-invasive rhinoplasty will set you back around $2500. Dr. Matarasso’s procedures average around $6-10K for surgical options and $2-$2500 for non-invasive rhinoplasty. Prices will vary by one’s anatomic makeup and goals as well as the region you live in. Check the americanboardcosmeticsurgery.com for rhinoplasty pricing in your neck of the woods.

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