Skin Excision as an Adjunctive Technique to Rhinoplasty in Middle-Aged and Elderly Patients

Caterson SA, Singh M, Kueckelhaus M, Caterson EJ, Eriksson E.

PubMed 26579338 Publisher (DOI)Free full text (PMC)

What this paper says

In 12 patients over 50, removing a lens-shaped strip of skin up to 1.6 cm wide along the root of the nose during rhinoplasty reduced skin redundancy, with minimal scarring and no complications at a minimum of one year.

Overview

The nose lengthens with age and the tip drops, while the skin loses elasticity. Reducing the bone and cartilage beneath skin that can no longer shrink to fit leaves loose skin and a poor result. The authors describe adding a direct skin excision to rhinoplasty in older patients, and include a review of published work on skin excision in rhinoplasty.

Sections of note

12 patients older than 50 years underwent lenticular skin excision as part of rhinoplasty.
Skin width removed measured up to 1.6 cm.
The excision was placed along the radix of the nose.
The stated result was reduced skin redundancy and prevention of tip droop.
Wounds healed with minimal scarring in all patients.
No complication was noted, with at least one year of follow-up for every patient. The paper also reviews the literature on skin excision in rhinoplasty.

What it means for a patient

The technique applies to older patients with thin, inelastic skin and a long nose with a drooping tip, not to routine rhinoplasty.
It trades a scar on the upper nose for the ability to remove skin that will not redrape on its own.
The authors report the scars healed well, but a scar in a visible midline location is the central trade-off.
Twelve patients, one centre, no comparison group and outcomes described rather than scored, so the evidence is preliminary.

Why this paper matters

Standard reduction rhinoplasty assumes the skin envelope will contract over the smaller framework beneath it, an assumption that fails in aged skin. Direct excision is the blunt answer to that failure. How the scar looks at five or ten years, and how patients themselves rate the trade, are not reported.

Terms

Lenticular excision: removal of a lens-shaped, pointed-oval strip of skin.
Radix: the root of the nose, the deepest point of the bridge between the eyes.
Skin redundancy: excess skin left over when the structure beneath is reduced.
Inelastic skin: skin that has lost the ability to shrink back after stretching.
Nasal tip ptosis: drooping of the nasal tip.
Reduction rhinoplasty: nasal surgery that removes bone or cartilage to make the nose smaller.

Summary written by rhinoplasty.cc from the abstract, 2026-09-08; not medical advice. The authors' own abstract follows.

Abstract

Rhinoplasty in middle-aged and elderly patients comes with its own set of challenges. There is relative lengthening of the nose with drooping of the nasal tip. With aging, the skin loses its elasticity, and the combination of nasal skeletal reduction along with overlying inelastic skin provides a setup for skin redundancy and poor postoperative outcome. We describe a surgical technique involving lenticular skin excision as a part of rhinoplasty in 12 patients older than 50 years to improve the aesthetic outcome. Skin width up to 1.6 cm was excised. Included is a literature review of skin excision in rhinoplasty. In elderly patients with thin, inelastic skin and long nose with a drooping tip, a reduction rhinoplasty technique might result in skin redundancy. Lenticular skin excision along the radix of the nose in these 12 patients improved the aesthetic outcome by decreasing the redundancy and preventing nasal tip ptosis. The wound from the skin resection healed in all the patients with minimal scar, and no complication was noted after at least 1 year of follow-up for each patient.

Abstract as indexed by PubMed; the article is open access (PubMed Central).