鼻与耳的多因素结构性衰老：软骨衰老与软组织重塑

文献信息

中文摘要

背景： 鼻与耳的衰老反映了软骨、软组织、纤维支撑及面部骨骼之间相互作用的改变。本综述探讨软骨衰老在这一多因素过程中的作用及其对治疗选择的意义。
方法： 通过PubMed、Google Scholar及相关专业文献进行叙述性文献综述，检索时间自数据库建库至2026年5月。综合组织学、生物化学、形态计量学及临床证据，以描述鼻与耳廓衰老特征，并评估填充剂、脂肪移植及手术的作用与局限性。
结果： 已报道的软骨改变包括基质耗竭、细胞密度降低及力学性质改变，耳廓软骨中可见弹性纤维破坏。在鼻部，软骨衰老与软组织重塑、纤维支撑减弱、肌肉力量及梨状孔-上颌骨骨骼改变相互作用，导致外观延长、鼻尖旋转度减小及鼻尖下垂。在耳部，软骨重塑影响耳廓轮廓与回弹，而耳垂延长与下垂主要涉及非软骨性纤维脂肪性耳垂。透明质酸填充剂可暂时改善部分轮廓或容积缺陷，但不能使软骨再生。鼻部填充剂治疗具有显著血管风险，而填充剂用于软骨性耳廓的证据仍有限。
结论： 复合解剖模型比单纯软骨萎缩更能解释鼻与耳廓衰老。治疗应针对主要组织异常，对于严重结构畸形或功能损害应考虑手术。
证据等级V： 本期刊要求作者对每篇适用循证医学分级的投稿指定证据等级。这排除了综述文章、书评以及涉及基础科学、动物研究、尸体研究和实验研究的稿件。有关这些循证医学评级的完整说明，请参阅目录或在线作者须知www.springer.com/00266。

英文摘要

BACKGROUND: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .