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Original Investigation
December 15, 2016

Technical and Clinical Considerations for Facial Feminization Surgery With Rhinoplasty and Related Procedures

Author Affiliations
  • 1FACIALTEAM Surgical Group, Marbella High Care International Hospital, Marbella, Málaga, Spain
JAMA Facial Plast Surg. Published online December 15, 2016. doi:10.1001/jamafacial.2016.1572
Key Points

Question  What is the role of rhinoplasty in facial feminization surgery with transgender patients?

Findings  In a case series study of 200 consecutive feminization rhinoplasties in combination with lip-lift techniques and forehead reconstruction, the frontonasal angle changed significantly and the degree of satisfaction after the rhinoplasty was high.

Meaning  Rhinoplasty, in conjunction with forehead reconstruction and lip-lift, is a key procedure to obtain adequate harmony in facial feminization surgery.

Abstract

Importance  Together with the forehead reconstruction, feminization of the nose is one of the most common procedures in facial feminization surgery. Rhinoplasty surgical techniques, which provide correct support and stability in the midterm to long term, are essential for obtaining a predictable result.

Objective  To report on the technical and clinical considerations of rhinoplasty and related procedures to feminize the nose, harmonize the nose in relation to the other modified structures (mainly the forehead and maxillomandibular complex), and achieve an aesthetic result beyond gender differences.

Design, Setting, and Participants  Case series study of feminization rhinoplasties, in combination with lip-lift techniques, forehead reconstruction, and other procedures, were performed at a private practice between January 11, 2010, and May 29, 2015, in 200 consecutive male-to-female transgender patients. The mean (SD) medical follow-up for patients was 32 (18.84) months (range, 12-77 months). Frontonasal angles were objectively measured. Postoperative and long-term patient satisfaction were assessed.

Main Outcomes and Measures  Clinical analysis and evaluation using the 5-point Nose Feminization Scale, with 1 indicating very masculine or nose is worse and 5 indicating very feminine or exceptional result.

Results  In these 200 patients, the mean (SD) age was 40.2 (12.2) years (range, 18-70 years). The mean (SE) frontonasal angle changed from 133.64° (0.63°) to 149.08° (0.57°) (difference in means, −15.44; 95% CI, −17.12 to −13.76; P < .001). Most patients considered their nose to appear more feminine after the surgery, and the degree of satisfaction after the rhinoplasty was 4 (much better) of 5 points on the Nose Feminization Scale. During the evaluation of feminization rhinoplasties, special attention was given to how the nose relates to other features essential to the identification of facial gender: the forehead and maxillomandibular complex. Emphasis was placed on the midterm to long-term stability of the results by reinforcing the internal structure.

Conclusions and Relevance  In this case series of feminization rhinoplasties in combination with lip-lift techniques and forehead reconstruction, frontonasal angles were changed, and patient satisfaction with outcomes was high. The main goal of rhinoplasty in facial feminization surgery is to obtain feminine nasal features and the harmonization of the nose with the rest of the face. Lip-lifts and frontonasal recontouring can complement rhinoplasties associated with facial feminization surgery.

Level of Evidence  4.

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