The nose does grow with age and that combined with generalised weakness of the soft tissues can result in the downward drooping of the nose with age. This has been well recognised by artists and classically depicted in Leonardo’s famous painting showing the differences between a youth facing an elderly man.
Loss of support of the nasal tip due to an absence or weakness of the nasal septum can result in droopiness or ptosis (pronounced toe-sis) of the tip. The nasal tip can be elevated or rotated by creating a strong scaffold either using a septal extension graft or a columellar strut. In some patient’s there is excessive length of the lower lateral cartilages and in this situation rotation of the tip can be performed by dividing the lateral crura and overlapping them thereby shortening the length of the lateral crus and elevating the nasal tip. This is often done in conjunction with a septal extension graft or columella strut. Please see before and after photographs as examples.