What is the minimum age for teenage rhinoplasty?

Rhinoplasty, commonly known as a "nose job," is a surgical procedure to reshape or resize the nose. It is a popular cosmetic surgery that can improve the appearance of the nose and enhance facial harmony. A recent study found that nearly half of the plastic surgeries performed on teenagers are rhinoplasties, making it the most popular adolescent plastic surgery procedure (1). However, one question that many people have is: when is the earliest age someone can have a rhinoplasty?

The answer to this question is not straightforward, as several factors must be considered before determining if a person is a good candidate for rhinoplasty. When considering a person's candidacy for rhinoplasty, we need to assess their midfacial skeletal development and emotional maturity.

It is important to note that rhinoplasty is a surgical procedure that requires careful consideration and planning. As such, it should only be performed on individuals who have fully developed physically and emotionally. Younger teenagers who are still growing and developing may not be good candidates for rhinoplasty, as their facial features may change over time.

There are two critical periods of nasal growth: the first takes place during the initial 2 to 5 years of life and the second during puberty. The pubertal nasal growth occurs between ages 12 and 16 years for females and 15 and 18 years for male. The nose continues to grow thereafter at different rates and duration as it relates to the timing of puberty. (2)

Nasal surgery in developing children may lead to unpredictable growth disruptions with stunted nasal and midface skeletal development or irregular septal cartilage growth. A longitudinal study of twins, one with septal destruction from an infection and the other normal, demonstrated significant growth abnormalities in the twin with the damaged septum. In children, alteration of the septal cartilage may cause cartilage loss, incomplete regeneration, or complete regeneration. Conversely, in adults, cartilage regeneration is not observed. (3) Despite the above risk, exceptions are made for children with severe nasal trauma, nasal masses, or significant septal deformities affecting breathing and dental development, whose expected benefit and improved quality of life from nasal surgery outweigh the potential for midface skeletal and cartilage growth disruption. (4) However, for teenagers without these extreme indications for urgent nasal surgery, waiting until their nose and nasal septum have grown sufficiently before surgery is best.

Because the second crucial period of nasal growth coincides with puberty, the onset of menarche can be used as a proxy for the onset of nasal development in females. A recent systematic review showed that rhinoplasty performed in patients at least 2 years after menarche exhibited more stable facial growth over time after rhinoplasty than those who had surgery less than 2 years after menarche. (5) 

The emotional maturity of the prospective rhinoplasty patient is equally important in determining whether rhinoplasty is right for them. A certain degree of intellectual maturity and insight is necessary when committing to any surgical procedure, particularly those that are elective in nature. These patients must demonstrate that they have clear and realistic expectations and are prepared to accept a certain degree of risk associated with the surgery. We have found that rhinoplasty can be transformative for patients who have been ridiculed or self-conscious about their nasal appearance. However, rhinoplasty should not substitute for the development of mature coping mechanisms.

Furthermore, rhinoplasty is a highly personalized procedure, and each patient's needs and goals are unique. Therefore, before the surgery, the patient (not the parent) should clearly know what they hope to achieve through the procedure and communicate this to their surgeon. The surgeon can then work with the patient to develop a customized surgical plan to achieve the desired results.

Given these nuances, our teenager rhinoplasty selection criteria have been refined to include patients with:

(1)   Stable height/growth for a minimum of 1 year as reported by their caregiver

(2)   At least 2 or more years after menarche for females

(3)   Demonstration of psychological readiness to undergo the proposed surgery

(4)   Demonstration of parental/family support

In addition to these factors, choosing a qualified and experienced surgeon to perform the rhinoplasty is essential. The surgeon should be board-certified and have extensive experience performing rhinoplasty surgeries. They should also be able to provide the patient with realistic expectations for the outcome of the surgery.

In summary, the typical earliest age someone can have a rhinoplasty is around 15-16 years old for females and 17-18 years old for males, when the nose has reached its adult size and shape. However, physical and psychological developmental maturity may vary significantly between individuals, and rhinoplasty candidacy must be assessed on a case-by-case basis.

(1) Rohrich RJ, Cho M-J. When is teenage plastic surgery versus cosmetic surgery okay? Reality versus hype: a systematic review. Plast Reconstr Surg 2018;142(3):293e–302

(2) Grymer LF, Bosch C. The nasal septum and the development of the midface. A longitudinal study of a pair of monozygotic twins. Rhinology. 1997 Mar;35(1):6-10. PMID: 9200255.

(3) Johnson, MD. Management of Pediatric Nasal Surgery (Rhinoplasty)  Facial plastic surgery clinics of North America, 2017, Vol.25 (2), p.211-221

(4) Adrian E. House, Kyohei Itamura, and Babak Azizzadeh.Consideration of Aesthetic Rhinoplasty in Children and Adolescents.Facial Plastic Surgery & Aesthetic Medicine. ahead of printhttp://doi.org/10.1089/fpsam.2022.0098

(5) Khetpal S, Dinis J, Peck C, et al. Utilizing age of menarche to optimize pediatric rhinoplasty. J Craniofac Surg 2021. [Epub ahead of print]; DOI: 10.1097/SCS.0000000000008132.