Surgeons’ Survey of the Aging Face With a Focus on the Aging Nose

Abstract

The purpose of this study was to evaluate how facial cosmetic surgeons rank different areas of the aging face by comparing those areas for the greatest impact on surgical rejuvenation. It was hypothesized that the nose would be ranked lower than most other areas of the aging face. Fifty surveys were included in this study and were completed by surgeons from the following specialties: oral and maxillofacial surgery, oculoplastic surgery, otolaryngology, general surgery, plastic surgery, dermatology, and obstetrics/gynecology. The 12 ranked areas of the face (from 1 to 12) were skin, hair/hairline, brows, periorbital area, nose, ears, cheeks, midface/nasolabial area, dentition, perioral area, lower face/chin/jowls, and neck. Each of these areas of the face was also rated based on the surgeons’ assessment of the level of importance when evaluating and treating the aging face on a 5-level scale, ranging from level 1 (not important) to level 5 (very important). The average rank for the nose was 9.30. The highest average ranking was the periorbital region with 2.74 and the lowest average ranking was the ears at 11.02. The surgeons’ ratings of the nose were 0% for level 1 (not important), 20% for level 2 (slightly important), 30% for level 3 (somewhat important), 26% for level 4 (important), and 16% for level 5 (very important). The average level rating of the nose was 3.413 (somewhat important). In comparison, the highest average rating was for the periorbital region at 4.837 (very important) and the lowest average rating was the ears at 2.957 (somewhat important). Using a significance level of P < .05, the nose is both ranked and rated as less important than 7 out of 11 other areas of the face: the periorbital area, the lower face, the skin, the neck, the midface, the perioral area, and the cheeks. The difference between the ranking and rating of the nose and that of the brows, dentition, hairline, and the ears was not considered significant. This study confirmed the hypothesis that when comparing the areas of the aging face that would have the most effect on surgical facial rejuvenation, the nose was ranked lower than most other areas of the face except the ears. The nose undergoes multiple anatomical changes with age that affect both appearance and nasal function. Therefore, the rhinoplasty for the aging nose should not be overlooked as an important contributor to facial rejuvenation and a potential to improve nasal function. The nose is most often considered of lower importance compared with other areas of the face by facial cosmetic surgeons when evaluated for impact on surgical facial rejuvenation.