The role of nasal feminization rhinoplasty in male-to-female gender reassignment

Objective: To objectively assess the results of rhinoplasty in feminizing the facial profiles of male-to-female transsexual patients undergoing gender reassignment. Methods: Twelve patients underwent nasal feminization as part of male-to-female gender reassignment. Global assessments of facial profile were performed, and nasofrontal, nasolabial, and supratip angles and the Goode ratio were objectively measured. Postoperative and long-term patient satisfaction was assessed. Results: The surgical procedures created more feminine nasal profiles in all patients. The mean +/- SD nasofrontal angle changed from 141.6 degrees +/- 6.0 degrees to 150.5 degrees +/- 5.5 degrees (P < .001). The nasolabial angle changed from 107.4 degrees +/- 14.3 degrees to 115.2 degrees +/- 11.7 degrees (P < .001), and the supratip angle from 1.7 degrees +/- 4.9 degrees to 12.8 degrees +/- 5.8 degrees (P < .001). The Goode ratio did not change significantly, remaining on average around 1.64 +/- 0.15. In 4 cases, spreader grafts were used to reconstruct the nasal valve, and no cases of valve insufficiency occurred. Conclusions: Rhinoplasty is effective in achieving feminine facial profiles in patients undergoing male-to-female gender reassignment. This requires reducing the overall nasal size and changing nasal angles to those more reminiscent of the female form. Because of the extensive resections often required to modify the nasal form, it is important to pay particular attention to preserving function, which may require concomitant nasal valve reconstruction.