Feminization Rhinoplasty

Impact of Gender-Affirming Rhinoplasty Techniques on Objective Facial Appearance

OBJECTIVES

To evaluate the impact of transfemale gender-affirming rhinoplasty on nasal appearance as evaluated by common facial analysis measures.

METHODS

Retrospective case series of patients undergoing gender-affirming nasal surgery at a single tertiary care center from March 2016 to July 2022. Pre- and postoperative photographs were analyzed, using iris width to normalize the measurements. Parametric tests were applied to identify differences in facial analytical measures.

RESULTS

A total of 33 male to female transgender patients met the inclusion criteria for study entry. Reductive rhinoplasty techniques were frequently utilized. Osteotomies and dorsal reduction were performed in 90.9% and 72.7% of cases, respectively. Tip width decreased on average by 2.3 mm. There was a mean increase of 10.0° in nasolabial angle, and 5.5° increase in nasofrontal angle. Among the 51.5% of patients who underwent alar base reduction, there was a mean decrease of 2.3 mm in alar base width, and 3.1 mm decrease in nasal width. Alar base excision and nasal tip grafting were utilized in 51.5% and 63.6% cases respectively.

CONCLUSIONS

Transfemale gender-affirming rhinoplasty techniques consistently and predictably altered facial analytical measures, and were effective in aligning nasal appearance with desired gender identity. Alar base excision and tip grafting were commonly employed techniques.

LEVEL OF EVIDENCE

4-Quantitative cohort study Laryngoscope, 135:1691-1696, 2025.

Functional and Cosmetic Considerations in Gender-Affirming Feminization Rhinoplasty

Gender-affirming facial surgery is increasing in prevalence, and rhinoplasty plays an integral role in its success. The nose displays considerable gender dimorphism, and maneuvers performed during gender-affirming rhinoplasty may differ considerably from those performed during cis-gender surgery. During feminization rhinoplasty in particular, cosmetic goals often rely on reductive techniques such as osteotomies, dorsal reduction, sidewall narrowing, tip narrowing, and alar base narrowing. These maneuvers collectively have important ramifications when considering the functional aspects of the nose. Herein, we outline the status of feminization rhinoplasty, and the interplay of cosmetic and functional considerations of the field.

Facial Feminization: Middle Third of the Face

Facial feminization surgery (FFS) as applied to the midfacial region targets modifications to the nasal and malar esthetic complexes. Although a global assessment is paramount in achieving desired functional results, most patients benefit from malar feminization in the form of bony and soft tissue augmentation, and nasal feminization in the form of reductive rhinoplasty. For patients with signs of aging, additional interventions in the form of rhytidectomy are powerful adjuncts to feminization. As with FFS techniques directed toward the upper and lower thirds, the overarching goal is to obtain complementary outcomes that enhance facial harmony and beauty.

Facial Gender-Affirming Surgery: Pitfalls, Complications, and How to Avoid Them

Facial feminization is a complex undertaking requiring skill in both craniofacial and aesthetic plastic surgery. As in aesthetic procedures, understanding the patient's goals and setting realistic expectations in light of an individual's anatomy is critical. Both soft tissue and bone must be addressed to adequately soften masculine facial features. This article delves into specific anatomic areas and delineates some of the pathways to successful outcomes.