The Rise of the Over-40 Nose Job

The stigma around plastic surgery has been consistently fading over the past years. “The culture is changing,” Nikki King-Chao, MD, an ENT head and neck surgeon who specializes in facial plastic surgery, including rhinoplasty, previously told Allure Philippines. “Many years ago, when you had rhinoplasty, the notion was, ‘Don’t tell others.’ Not anymore. Today, people capture their journeys online.”

AIVEE Group co-founder and dermatologist Dr. Aivee Aguilar-Teo confirmed this during the Allure Beauty Congress last November 21, 2025. “When I started my practice way back 2009, my patients were very embarrassed. They were hiding [while] doing aesthetic treatments,” she shares. But now, “It’s become more open and more transparent. People are actually sharing [more], not only among friends, but even in their social media pages.”

But that’s not the only shift we’re seeing. Rhinoplasty, long viewed as an operation for high-schoolers and college kids, is also gaining popularity among midlifers. 

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 percent 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.

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.

Why now? Behind the rise of midlife rhinoplasties

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, 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.”

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 surgeries done years ago, when the desired aesthetic was small and scooped, and the techniques for creating it were reductive and unrefined. In the ‘80s and ‘90s, especially, the goal was cuteness at all costs. “In going for something very small, surgeons were taking away a lot of cartilage,” Dr. Doft explains. Since they’d routinely downsize noses without adding supportive cartilage grafts, noses tended to collapse over time, leaving patients with deformities and breathing issues. Overdone noses often developed a pointy and severe look—an angularity that added years to the face, notes Dr. Doft—compelling some patients to eventually seek second or third surgeries. Many revision rhinoplasty patients have simply outgrown the “pinched, upturned nose” of their teens, says Dr. Rizk, and are hoping for a “more elegant, age-appropriate look.”

For first-time patients and repeat customers alike, the promise of unobstructed breathing may be leading them to surgery. Dr. Lee sees the virality of breathwork, nasal breathing, and mouth taping—wellness trends focused on the potential health and relaxation benefits of proper breathing—pushing people to correct long-ignored deviated septums and other anatomical abnormalities that impair breathing. And oftentimes what starts out as a purely functional procedure, to help improve airflow, becomes what Dr. Lee calls a “while-you’re-in-there surgery,” as in: While you’re in there fixing my crooked septum, why not smooth out that bump that I’ve forever been self-conscious about.

The “non nose-job nose job”

For older patients, the nose job of the moment isn’t trending on TikTok. It’s not the hashtag Hollywood nose or Barbie nose or Turkish nose. It is, rather, the “non nose-job nose job,” to borrow a phrase from Dr. Doft. What midlifers are typically going for, she says, “is a straight, sophisticated nose, not too much of an upturn, with maybe a little bit of a break between the nasal bridge and the tip,” she says. “They want something conservative that’s in proportion with the rest of their face.” It’s a classic shape that “transcends time,” she adds. It’s not something that looks adorable at 16, but silly at 47.

Bolstering an aging nose and enhancing breathing generally means “deploying more cartilage grafts for structural support, especially to reinforce weakened areas of cartilage,” notes Dr. Kolker. It means augmenting rather than reducing the nose. But my sources say more patients, men and women both, are comfortable with stronger noses—profiles that have some presence—particularly when they align with their personal or cultural identity. “My nose is still, you know, when I say big, I don’t mean it in a bad way. It just is—I have big features, so it fits,” says Fessler.

Those who’ve seen time leave its mark often “just want their nose to look a little more youthful,” says Dr. Rizk. They’re not asking for an overhaul or expecting perfection. Since even minor refinements can have a profoundly rejuvenating effect, rhinoplasty on an older patient may entail “relatively easy” adjustments, says Dr. Lee, like “softening the hump and slightly lifting the tip.” In many cases, surgeons are modifying only the tip of the nose, Dr. Doft adds, raising it, slimming it, defining it, or, especially with revisions, “giving it a little more volume and covering by adding a layer of tissue to the tip, so it looks softer and not quite as pointy.”

“I watched my face get more structured as I got older, and my nose seemed to stand out more.”

Such modest changes can sometimes curtail downtime. Dr. Tepper recently did a rhinoplasty on a woman in her 50s who wanted only a slight reshaping of the cartilage, but no bony work. “We did it on a Thursday, and she was back in the office on Monday,” he says. However, when the nasal bones are fractured and moved—to narrow a bridge, for instance, for a more dramatic transformation—patients have considerably more bruising and swelling. The bones take about four weeks to heal and final results won’t come until one year.

Above all, older rhinoplasty patients are bound by their intense desire for subtlety. “They’ve had this nose for decades and they’re less tolerant of big changes,” Dr. Chang says. Many are actually “terrified of looking like someone else,” adds Dr. Kolker. This rings especially true for those who have children. (With the latest 3D imaging, surgeons can give patients a good sense of what they might look like after surgery, says Dr. Tepper, to prevent unwanted surprises.) Before 46-year-old Lori got a rhinoplasty with Dr. Kolker she told him, “I’m only looking for a subtle refinement. Nothing dramatic. Just my nose, only better.” He understood the assignment. “I’m not sure my parents even noticed when I saw them a few months [after the surgery],” she says. (She’d kept them in the dark because “they’re not really open-minded about cosmetic procedures.”)

The best rhinoplasty surgeons will actually insist on conservative, less-is-more adjustments for older patients, whose sense of self is fully formed. “At an emotional level, an overdone nose can mean an identity crisis,” Dr. Kolker warns.

Upsides of an over-40 nose job

Once patients are on the other side of plastic surgery, they often say they wish they’d done it sooner—if only to have freed themselves, years earlier, from the burden of obsessing over a source of insecurity. But there may be advantages to waiting to go under the knife. For starters, our tastes tend to be more refined and less volatile when we’re older. At 46 versus 16, says Dr. Lee, “you know who you are and what you like, so we’re not operating on a target that might change.”

What’s more, rhinoplasty techniques have evolved alongside aesthetic preferences. “Huge, paradigm shifts have happened over the last 30 or 40 years,” Dr. Kolker says. Surgeons today generally aim to preserve as much natural tissue as possible, so as not to completely upend the original anatomy, which can destabilize the nose. And some rhinoplasty specialists have traded their old-school hammers and chisels for piezotomes, which use ultrasonic waves to “more delicately and precisely break and reshape” the nose, according to Dr. Chang. Others have held onto their traditional tools, feeling they offer more control and finesse. While the pros and cons of “piezo rhinoplasty” are hotly debated at global aesthetic meetings, Dr. Rizk credits his “ultrasonic shaver” with generating less swelling during surgery. “And less swelling means less [internal] scar tissue,” he says, which can translate to a quicker recovery, better result, and less chance of revision.

“You know who you are and what you like, so we’re not operating on a target that might change.”Advancements in anesthesia have also made rhinoplasty safer and more predictable. Some rhinoplasty surgeons have adopted propofol—a familiar friend to any midlifer who’s had a colonoscopy—and this, says Dr. Doft, can make for an easier, less daunting experience. Overall, nose jobs “used to be a much bigger deal,” she says, requiring a hospital stay, prescription pain meds, and weeks of hibernating. But now, “people are realizing it’s not as bad as they thought it was,” adds Dr. Lee, thanks, in part, to the deluge of recovery journeys on social media (#nosejobcheck). “It’s mostly a Tylenol pain. It feels like a cold.” Lisa agrees with that assessment: “It’s uncomfortable for the first couple of days, that stuffed up feeling, but no pain.” And Margot went even further when asked about her nose job recovery: “Zero pain, literally zero pain, unless you bump your nose by accident, so, you know, don’t do that.” Her swelling on the other hand was far from zero. “There’s a lot of swelling at first and it can take forever for it to go down,” she says. “Especially if you have very thick or sebaceous skin, like I do, so you have to be patient.”