The Over-40 Nose Job

03.12.2025, 16:29 allure.com

With toddlers wearing sheet masks, tweens buying wrinkle serums, and 30-somethings booking facelifts, it may seem like the beauty industry itself is aging backwards—its rituals and treatments getting younger along with its consumers. But there’s one procedure that’s flipping the script on the trend, appealing to a far older crowd than it has in the past. Rhinoplasty, long viewed as an operation for high-schoolers and college kids, is gaining popularity among midlifers. For the past two years, 40- to 54-year-olds have gotten roughly as many nose jobs as patients in their 20s, according to the American Society of Plastic Surgeons, with each age group accounting for 26% of the total number of nose jobs performed in both 2023 and 2024.

In Beverly Hills, half of the patients who see board-certified plastic surgeon Catherine Chang, MD, for rhinoplasties are over 40. Linda N. Lee, MD, a double board-certified facial plastic surgeon in Boston, says more than 50% of the nose jobs she performs are on middle-aged women and men, noting that, in her case, there may be some selection bias in play; she tends to avoid operating on patients who are still growing, physically and emotionally, which limits the number of teens she treats. Some of the other surgeons I spoke with estimate that the 40-plus set comprises closer to 15% or 20% of rhinoplasty cases, but “that’s definitely more than I did five years ago,” says Adam Kolker, MD, a board-certified plastic surgeon in New York City.

A 46-year-old patient before her rhinoplasty…

… and after surgery.

Oren Tepper, MD, a board-certified plastic surgeon in New York City, says that when he first started his practice, he’d almost have to “take pause initially” when an older person came in wanting their nose done. He’d wonder why they didn’t consider surgery during a more conventional phase of life. (Prime time for rhinoplasty still generally falls into the transitional zones between high school and college or college graduation and a first job, he says, when the physical transformation can be “less jarring and more acceptable.”) He’s since come to realize that patients have all sorts of reasons for delaying nose jobs—and that some people want to tweak their nose at 40 or 50 even if it never bothered them before.

Still, some of those approaching rhinoplasty later in life do so with trepidation, notes Melissa Doft, MD, a board-certified plastic surgeon in New York City. They’ll commonly say, I should have done this when I was younger. Or ask, Is it ridiculous that I’m thinking about doing this now? While the stigma around plastic surgery has faded in certain circles, nose jobs are still strongly associated with the awkward toll of puberty. Dr. Doft puts patients at ease by explaining that midlife rhinoplasty “is actually more common than you think,” as a lot of adults are now pairing it with other procedures, like facelifts and eyelid lifts, in the name of facial rejuvenation. In fact, a study out of UCLA, which used an age-estimating AI tech to compare before and after photos, found that women appeared three years younger following rhinoplasty alone.

For younger generations, it’s hard to imagine a world without iPhones and Instagram. But the Gen Xers exploring rhinoplasty in 2025 grew up without these modern staples—and the extreme self-consciousness they tend to promote. “When we were 18 or 20, we looked in the mirror while brushing our teeth in the morning and mentally carried that image with us for the whole day,” Dr. Doft says. Photos were typically taken with us smiling at the camera, capturing that same straight-on reflection and rarely revealing our profiles. But now “we’re exposed in a way that we’ve never been exposed before—our every angle is out there,” Dr. Doft says. “It’s just a totally different level of pressure.”

Back in the day, rhinoplasty—plastic surgery, in general—had certain geographic strongholds, like Los Angeles and New York City, but it wasn’t nearly as ubiquitous as it is today. Even if someone was embarrassed by their nose—because bullying, unlike selfies, is not a 21st-century invention—the idea of cosmetic surgery may have felt foreign, scary, or extravagant. And, so, “they put it off for years,” Dr. Kolker says.

While the stigma around plastic surgery has faded, nose jobs are still strongly associated with the awkward toll of puberty.

“I’d wanted to get my nose done since I was 16, but my parents were absolutely not going to pay for a nose job. And where I grew up, in central Florida, plastic surgery wasn’t a thing that people did, especially in the ‘90s,” says Margot*, who got a rhinoplasty along with a facelift in her 40s. It wasn’t until her late 30s that she felt she was in a place, career-wise, where she could devote the necessary resources to surgery and recovery. Around the same time, she’d begun contemplating a facelift to address some early laxity along her jawline. The surgery presented an opportunity to address two insecurities in one fell swoop. She asked Dr. Doft to remove the small bump from her nose and narrow the tip. Now, she says, “I still look like myself, but my nose is sleeker and just fits my face a lot better.”

For some patients, their nose is a new insecurity. “The nose changes as we get older,” says Dr. Doft. What was once a perfectly-fine feature can suddenly start “looking a little longer, wider, or droopier” due to age-related facial shifts. Yes, even the nose can show its age. Dr. Chang tells me that the majority of older patients who come in for rhinoplasty feel that time has accentuated the aspects of their nose that only low-key bugged them when they were younger. How so? The nose has a tendency not to grow, per se—that’s a common misconception—but to morph slightly, over decades, in ways that make it more conspicuous. (An “ideal” nose, surgeons say, is one that goes unnoticed.) As aging skin thins out, the nose can appear longer, the tip can curve downwards, and bumps and asymmetries (once concealed by a blanket of soft tissue) may reveal themselves. “You can have a really minor dorsal hump all your life, and then as your tip gets a little bit droopier, that hump becomes more obvious,” Dr. Lee explains. In other cases, the skin of the nose can get thicker and more sebaceous, making a defined tip look “bulbous.”

Sometimes the nose itself doesn’t fluctuate all that much, but it can appear more prominent as the cheeks deflate and sag, and the chin begins to recede. (Nose jobs and chin implants have long gone hand-in-hand for this very reason.) For women, the hormonal shifts of menopause can “very significantly affect skin elasticity and soft tissue quality as well as bone density, to an extent,” notes Dr. Kolker, all of which “can change how the nose sits in the context of the face.”

Throughout early adulthood, Lisa*, a patient of Dr. Tepper, had never loved her nose, but it wasn’t until her 30s that it started to really bother her. “I watched my face change and get more structured as I got older, and my nose seemed to stand out more,” she says. “The tip was more rounded than I liked and I wanted the bridge to be slightly thinner, but it was very important to me that [the change] wasn’t too drastic.” At 40, after having two kids, she made time to invest in herself, booking a rhinoplasty and a tummy tuck. “This was a big part of me reclaiming myself, feeling great in my skin again,” she says.

One study found that women appeared three years younger following rhinoplasty alone.

In New York City, double board-certified facial plastic surgeon Sam Rizk, MD, frequently tweaks the nose at the time of a facelift. “I must do at least 100 facelifts with rhinoplasty a year,” he says. During facelift consultations, patients “usually talk about the fact that their nose has drooped.” In the past, when Dr. Rizk more commonly performed facelifts separate from rhinoplasties, patients would come back post-lift complaining that their nose didn’t fit their new face. Now, when desired and appropriate, he encourages patients to combine the two operations for the most harmonious result.

Such was the case with Jennifer Fessler of The Real Housewives of New Jersey. She saw Dr. Rizk for a deep plane facelift and a rhinoplasty in 2023 at the age of 54. Fessler says her nose had always been somewhat prominent, but it fit her face and looked proportional to her other features. Something changed as she entered her 50s, though: “I felt like my nose was spreading across my face, with these nostrils flaring out, and I just couldn’t get a good picture,” she says. In photos, “all I could see was jowls, neck, and nose.” She trusted Dr. Rizk to rectify the situation without giving her “a little button nose,” which would’ve clashed with her personal aesthetic. Now, when she sees herself in the mirror or on a screen, she says she doesn’t notice her nose, which is precisely the goal of a good nose job. And even though she paired the procedure with a facelift, she says she “breezed through” the recovery and “was out a week and a half later at a Super Bowl party.”

Jennifer Fessler, 55, before rhinoplasty and a facelift in 2023…

… and after the surgeries.

Not all surgeons like to bundle a facelift with rhinoplasty, though. “I like to do the nose all-in, obsessing over every millimeter, and then let you heal,” says Dr. Lee. “When that’s done, we can go back and do another part of the face.” Likewise, Dr. Kolker does rhinoplasty as a standalone procedure, since he feels it demands his “undivided attention.” In select cases, Dr. Chang finds that “the nose can actually look more balanced after a facelift,” once the midface is elevated and volume restored, so she may suggest doing the lift first and reassessing the need for a nose job months later.

Also contributing to the uptick in midlife rhinoplasties are people who did have nose jobs in the past, but are no longer happy with the results. About half of the over-40 nose jobs that Dr. Rizk performs are revisions of surg