Ronald P. Gruber, MD Nicolas Tabbal, MD Ira D. Papel, MD Stephen E. Metzinger, MD Dr. Gruber: Since this panel is about the aging or senile nose, most of the patients under discussion will be older. This topic is significant because people tend to have weaker tissues as they age. This weakness, coupled with the effect of gravity, results in patients who suffer not only from the aesthetic problems of an elongated nose, but also from problems of airway obstruction. Another factor to consider when treating these patients is that they have different expectations from surgery than younger patients. The first patient is a 68-year-old woman who was not specific about her nasal deformity; she simply wanted an “improved appearance” of her nose (Figure 1). Dr. Tabbal, how would you approach this patient? Would you have reservations about treating her? Figure 1 A-C, This 68-year-old woman would like to improve the appearance of her nose. Dr. Tabbal: What strikes me is that if this patient is looking for ways to rejuvenate or improve her appearance, then she should consider other treatment modalities for facial rejuvenation since her nose is quite benign. She has diminished skin elasticity over the bridge, and the skin of the nasal lobule is quite thick. If she wants to improve her nasal appearance, changes would have to be conservative. Anatomically, this is not a difficult nose to improve. I would use a closed approach, performing a very conservative lowering of her dorsum, shortening the nose, and probably narrowing her nasal base. I would be cautious with the osteotomies because patients in this age group tend to have brittle nasal bones. Dr. Gruber: Dr. Metzinger, when a patient of this age consults with you and wants the nose, and the nose only, improved, does that concern you in terms …