Surgical anatomy of the nose in the elderly: value of conservative rhinoplasty by transoral route.

Functional or aesthetic rhinoplasty is being done later and later in life. It is essential to know the characteristics of morphological ageing of the nose in order to modify surgical techniques. An anatomical study was carried out on 40 fresh cadavers more than 70 years old. All the subjects studied were measured to define the external morphology of the nose. Amongst these 40 subjects, 20 were dissected plane by plane, 10 were operated on by a new conservative rhinoplasty technique utilizing a strictly transoral route and 10 were operated on by a classical rhinoplasty technique. The anatomy of the nose in the elderly subject is characterized by thinner skin, subcutaneous fat infiltrating in the muscles in 50% of cases and the small muscles of the tip of the nose undergoing complete involution. The technique of rhinoplasty described here shows the value of better respecting lesions at the tip of the nose which is particularly fragile in the aged subject. It may be extended to post-traumatic rhinoplasties or to the nose which has already been operated on.