Background <p>Rhinoplasty, one of the most complex and commonly performed procedures in facial plastic surgery, presents unique challenges when performed on older adults. This study evaluates the challenges and outcomes of rhinoplasty in elderly adults, focusing on aesthetic and functional results.</p> Methods <p>A retrospective analysis was conducted on 50 patients aged 45 and elderly who underwent primary rhinoplasty. Data collected included demographics, preoperative anatomical assessments, surgical techniques, and postoperative outcomes. All procedures adhered to a standardized approach, incorporating septoplasty, hump reduction, and various grafting techniques to address both functional and aesthetic objectives. Primary measures were nasal length, nasolabial angle, and Visual Analog Scale scores for nasal obstruction.</p> Results <p>The sample was balanced by gender, with a mean age of 57.3 ± 3.9 years and an average follow-up period of 15.1 ± 2.2 months. Fitzpatrick skin types and sebaceous skin classification did not differ significantly by gender (<i>p</i> &gt; 0.05). Postoperative outcomes demonstrated significant improvements: nasal length decreased from 59.04&#xa0;mm to 40.96&#xa0;mm, and the nasolabial angle increased from 79.1° to 106.1° (<i>p</i> &lt; 0.001).</p> Conclusion <p>When considering age-related anatomical nuances and advanced techniques like grafting, rhinoplasty in elderly adults can achieve high satisfaction rates and notable functional enhancements. These findings underscore the viability and efficacy of rhinoplasty in elderly patients, highlighting its potential for long-lasting aesthetic and functional benefits.</p> Level of Evidence <p>Level IV, risk/prognostic study.</p>