Americans over the age of 65 represent one of the fastest growing segments of our population. Rhinoplasty in the elderly man presents a unique set of obstacles. In addition to the typical forces of healing and scar contracture, the aging nose features the altered anatomy and physiology of aging added to an already complicated three-dimensional structure. The heavier, thicker, and more sebaceous skin of men can exacerbate the loss of support associated with aging, creating a scenario of worse functional issues in men as compared with their female counterparts. Approaching the aging nose requires an appreciation of the nuances of the preoperative, intraoperative, and postoperative phases of the patient interaction. Although functional issues predominate in this population, aesthetic concerns also need to be addressed.