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Changes in the bony foundation that support the nose in youth, the paired nasal bone, and the ascending processes of the maxillae are responsible for many of the soft tissues changes seen in the nose with aging. Similarly, bone loss is not uniform, with the greatest resorption occurring in the ascending process of the maxilla. Pessa measured the length of the perpendicular line from the nasion to the pyriform on standardized lateral views of three-dimensional CT images and observed that the distance increases significantly with aging, indicating preferential bone loss in the lower part of the pyriform aperture (Fig.
This manifests clinically as posterior displacement of the alar base (relative to the fixed position of the medial canthus) (Fig.