Multifactorial Structural Aging of the Nose and Ear: Cartilage Senescence and Soft-Tissue Remodeling

Aging of the nose and ear reflects interacting changes in cartilage, soft tissues, fibrous support, and the facial skeleton. This review examines the contribution of cartilage senescence within this multifactorial process and its implications for treatment selection.

A narrative literature review was conducted using PubMed, Google Scholar, and relevant specialty literature from database inception through May 2026. Histologic, biochemical, morphometric, and clinical evidence was synthesized to characterize nasal and auricular aging and evaluate the roles and limitations of fillers, fat grafting, and surgery.

Reported cartilage changes include matrix depletion, reduced cellularity, and altered mechanical properties, with elastic fiber disruption in auricular cartilage. In the nose, cartilage senescence interacts with soft-tissue remodeling, weakened fibrous support, muscular forces, and pyriform-maxillary skeletal change, contributing to apparent lengthening, reduced tip rotation, and tip descent. In the ear, cartilage remodeling affects auricular contour and recoil, whereas earlobe elongation and ptosis predominantly involve the noncartilaginous fibrofatty lobule. Hyaluronic acid fillers may temporarily improve selected contour or volume deficiencies but do not regenerate cartilage. Nasal filler treatment carries substantial vascular risk, and evidence for filler use in the cartilaginous auricle remains limited.

A composite anatomic model better explains nasal and auricular aging than cartilage atrophy alone. Treatment should address the dominant tissue abnormality, with surgery considered for major structural deformity or functional impairment.

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