The Impact of Age on Anthropometric Changes Following Rhinoplasty

Background: There are several factors affecting the results of rhinoplasty, and the predictability of outcomes still remains insufficient. Objective: To associate the rhinoplasty results with patients' age by anthropometric measurements. Methods: Retrospective chart review of patients undergoing rhinoplasty who were divided into decades of age. Anthropometric measurements were carried out using Rhinobase® Software. Wilcoxon t test was used for the postoperative 3 months and 2 years analysis. p values of <0.05 were considered statistically significant. Results: A total of 243 patients (median age: 37.1; M:F = 68:175) were included in the study: group I (19-29 years) n: 80; group II (30-39 years) n:71; group III (40-49 years) n: 48; and group IV (50-61 years) n: 44. In group IV, the highest value of difference (Δ) was seen in the midfacial height with the number of 5.5 ± 1.1 (mm) (<0.001). The values of nasal length, tip projection, and midfacial height parameters showed significant differences in both group III and group IV. Conclusions: Unfavorable age-related changes in long-term postoperative period following rhinoplasty can occur in patients above 40 years of age.

Making the Subjective Objective: Machine Learning and Rhinoplasty

BACKGROUND

Machine learning represents a new frontier in surgical innovation. The ranking Convolutional Neural Network (CNN) is a novel machine learning algorithm that helps elucidate patterns and features of aging that are not always appreciable with the human eye.

OBJECTIVES

The authors sought to determine the impact of aesthetic rhinoplasty on facial aging employing a multidimensional facial recognition and comparison software.

METHODS

A retrospective chart review and subsequent analysis was carried out on all female patients who underwent open rhinoplasty with the senior author from 2014 through 2018 and had postoperative photos at 12 or more weeks follow-up. All photos were analyzed with Microsoft Azure Face API (Redmond, WA), which estimates patients' age by cropping the face from a photograph and then extracting a CNN-based prediction through multiple deep neural networks.

RESULTS

A total of 100 patients ultimately met full inclusion criteria. The average post-surgical follow up for this cohort was 29 weeks (median, 14 weeks; range, 12-64 weeks). Patients ranged from 16 to 72 years old (mean, 32.75 years; median, 28.00 years; standard deviation, 12.79 years). The ranking CNN algorithm on average estimated patients preoperatively to be 0.03 years older than their actual age. The correlation coefficient between actual age and predicted preoperative age was r = 0.91. On average, patients were found to look younger post-open rhinoplasty (-3.10 vs 0.03 years, P < 0.0001).

CONCLUSIONS

The ranking CNN algorithm is both accurate and precise in estimating human age before and after cosmetic rhinoplasty. Given the resulting data, the effects of open rhinoplasty on reversing signs of facial aging should be revisited.

LEVEL OF EVIDENCE: 4

Aesthetic Motivation of Geriatric Rhinoplasty The Surgical Outcome

BACKGROUND

Rhinoplasty in the elderly population has recently emerged as an issue in terms of rejuvenation. There, however, is a paucity of published data on geriatric rhinoplasty in Asian patients. The aims of this study were to investigate the motivation of aged Korean patients to undergo the procedure, and to demonstrate our experience of rhinoplasty in patients of 60 years of age and older.

METHODS

A total of 20 patients, 11 men and 9 women, underwent rhinoplasty between December 2003 and September 2012 at the Asan Medical Center. Anthropometric measurements were performed preoperatively and postoperatively. Two independent ENT surgeons viewed photographs to assess the surgical outcomes. Patient satisfaction was graded using a visual analogue scale (from 1 = dissatisfied, to 4 = satisfied) by telephone interview.

RESULTS

The rhinoplasty performed in our patient cohort aimed to address deviated nose (30%), postinfectious deformed nose (15%), flat nose (15%), saddle nose (10%), and additional cosmetic rhinoplasty for planned septoplasty (10%). Anthropometric measurements showed statistically significant improvements in nasal tip projection, nasal length, dorsal height, and radix height. The mean satisfaction scores were 2.9 for physicians and 2.5 for patients. Three patients (15%) experienced incomplete improvement of nasal obstruction, and 7 patients (35%) expressed aesthetic dissatisfaction about tip shape or dorsal deviation after rhinoplasty. Three patients (15%) underwent revision rhinoplasty.

CONCLUSIONS

The aged patients in this study received rhinoplasty to resolve their long-cherished desires. If elderly patients have no risk of general condition, surgeons do not need to discourage a patient's wish to improve their appearance.

External Approach for the Treatment of the Aging Nasal Tip

Changes seen in the nose from increased skin elasticity, weakened nasal cartilages, and detachment of ligaments can lead to cosmetic and functional impairment. Esthetically, the nasal tip droops, the nose lengthens, the columella shortens, and the ala collapse. Functionally, the internal and external nasal valves weaken, the anterior nares narrow, and airway turbulence increases, thus contributing to the effect of nasal obstruction. Skin redundancy of the elderly nose may compromise outcomes when typical rhinoplasty techniques are applied. Herein is described a technique pioneered by Fred Stucker, involving a direct external approach to address the aging nasal tip. The technique can be performed under local anesthesia and in combination with other procedures for the aging nose, such as rhinophyma excision or septoplasty for the aging nose.

How to cite this article

Hu M. External Approach for the Treatment of the Aging Nasal Tip. Int J Head Neck Surg 2016;7(3):165-167.

Age-related histologic changes in human nasal cartilage

IMPORTANCE

Understanding age-related changes is important when considering cartilage-based implants or grafts during rhinoplasty and nasal reconstructive surgery.

OBJECTIVE

To characterize the cellular and architectural changes in human nasal cartilage with aging.

DESIGN

Laboratory study.

PARTICIPANTS

Nasal septal cartilage was harvested from 50 consecutive patients undergoing septoplasty, rhinoplasty, or septorhinoplasty.

INTERVENTION

Cartilage specimens were stained with hematoxylin-eosin (H&E) and safranin O for cartilage.

MAIN OUTCOME MEASURES

A modified Mankin histologic grading scale was used to analyze each cartilage sample for H&E findings and safranin O staining. Higher H&E scores indicated more degenerative changes, while higher safranin O scores indicated reductions in proteoglycan content within the cartilage matrix, representing decreased active chondrocyte activity. Correlation between H&E and safranin O scores and patient age was determined.

RESULTS

There was positive correlation between safranin O staining scores and age, with higher scores seen with advancing age (P = .01). A linear regression best-fit equation was determined to calculate a potential safranin O staining score for a given age.

CONCLUSIONS AND RELEVANCE

We have quantitatively determined that advancing age is positively correlated with reductions in cartilage proteoglycan content and active cartilage growth. This finding not only enhances our current understanding of the natural changes that occur in cartilage with aging but may also affect surgical decision making when cartilage grafting is considered during functional, reconstructive, and aesthetic rhinoplasty.

LEVEL OF EVIDENCE

NR.

The efficacy of rhinoplasty alone in facial rejuvenation

PURPOSE

The aim of the study was to demonstrate whether rhinoplasty alone is a rejuvenating procedure for the aging face.

MATERIALS AND METHODS

Photographs of the right profile of 48 white females older than 55 years were recorded using standardized techniques. Each of the subjects' noses underwent computer-simulated rhinoplasty to conform to aesthetic canons of the ideal nose. Forty-eight evaluators, blinded to the purpose of the study, were shown either the natural right profile or the morphed image. The evaluators then estimated subject age.

RESULTS

Evaluators were divided into younger and older cohorts. Computer-simulated rhinoplasty alone did not prove to be statistically rejuvenating (Hotelling-Lawley Trace, P = .203). This finding held true for both the younger and older cohort of evaluators (P = .98). Although not statistically significant, evaluators estimated the age of the morphed images to be 6.5 years (mean) younger than actual age for all subjects.

CONCLUSIONS

Rhinoplasty alone is not statistically rejuvenating in the profile view of white females older than 55 years. However, age estimation may be less accurate than was hypothesized for the profile view, possibly because of other visual queues.

Secondary cleft rhinoplasty rejuvenates the nose: a suggestion from a panel survey

BACKGROUND

Cleft-lip nasal deformity (CLND) affects the overall facial appearance and attractiveness. The CLND nose shares some features in part with the aging nose.

OBJECTIVES

This questionnaire survey examined: 1) the panel perceptions of the role of secondary cleft rhinoplasty in nasal rejuvenation; and 2) the influence of a medical background in cleft care, age and gender of the panel members on the estimated age of the CLND nose.

STUDY DESIGN

Using a cross-sectional study design, we enrolled a random sample of adult laypersons and health care providers. The predictor variables were secondary cleft rhinoplasty (before/after) and a medical background in cleft care (yes/no). The outcome variable was the estimated age of nose in photographs derived from 8 German nonsyndromic CLND patients. Other study variables included age, gender, and career of the assessors. Appropriate descriptive and univariate statistics were computed, and a P value of <.05 was considered to be statistically significant.

RESULTS

The sample consisted of 507 lay volunteers and 51 medical experts (407 [72.9%] were female; mean age ± SD = 24.9 ± 8.2 y). The estimated age of the CLND noses was higher than their real age. The rhinoplasty decreased the estimated age to a statistically significant degree (P < .0001). A medical background, age, and gender of the participants were not individually associated with their votes (P > .05).

CONCLUSIONS

The results of this study suggest that CLND noses lack youthful appearance. Secondary cleft rhinoplasty rejuvenates the nose and makes it come close to the actual age of the patients.