Ethnic Considerations for Rhinoplasty in Facial Feminization

Abstract

To the Editor The recent publication by Bellinga and colleagues 1 highlights a case series of feminization rhinoplasties to identify important factors to achieve superior long-term results and to improve patient satisfaction. This work contributes to a small but growing collection of research in facial feminization, which has become an area of interest in facial plastic surgery. The authors highlight the importance of sufficient long-term support and stability through manipulation of the osteocartilaginous skeleton of the nose and cartilage grafting as well as lip-lift and nasofrontal transition modification for improved aesthetic outcomes. The authors identify 3 objectives in planning a rhinoplasty in the context of facial feminization surgery, including feminization of the nose, creating harmony between the feminized nose and other modified facial structures, and achieving aesthetic results that transcend gender differences.In the Invited Commentary for that article, Spiegel 2 notes that in facial feminization, it is important to create an unambiguously feminine form of the nose because the transgender woman must overcome a constellation of physical traits that send male gender cues. The female nose is described as having a straight narrow bridge, well-defined projecting tip, refined alae, and a nasolabial angle of approximately 95°to 100°. 3 However, as with most aesthetic ideals, these characteristics are the ideal for white women and may not result in a successful and racially congruent aesthetic result in all patients. Many studies have been published describing differences in the nasal aesthetics of different ethnicities; in their comprehensive review, Rohrich and Bolden 3 described the multiple anatomic variants of nasal aesthetics even within each ethnic group, which highlights the importance of ethnic rhinoplasty techniques.Facial feminization surgery can significantly enhance the quality of life and reduce the psychosocial sequelae faced by transgender women, who are often marginalized and discriminated against in health care and society. 4,5 When planning for rhinoplasty in facial feminization, it is imperative that the surgeon does not rely solely on the aesthetic standards used for white rhinoplasty patients or classic rhinoplasty techniques in transgender women of other ethnicities. The surgeon should determine each individual patient's aesthetic goals during the preoperative consultation and develop a surgical plan that is informed by the patient's anatomy, ethnicity, and desires to achieve a result that is feminine, aesthetically pleasing, and harmonious in the context of the entire feminized face.

Perception of femininity and attractiveness in Facial Feminization Surgery

“…The individual depicted in our study was Caucasian, and 80.6% of transgender female respondents identified as white. Although the analysis of demographics show no difference in perception of femininity, attractiveness, and ideal surgical outcome between ethnicities, the inclusion of faces from different ethnicities may alter the results in future studies (24)(25)(26). The sample size of plastic surgeons is small, despite our outreach efforts.…”

Feminizing Rhinoplasty: A Systematic and Institutional Review of Operative Techniques and Clinical Outcomes

“…1 Among the many aspects of human body, the face is the most defining characteristic of a person and generates composite cues on gender identity. [2][3][4][5] While manifestations of GD are highly individualized, patients who pursue facial gender affirmation surgery sustain dysphoria from their facial features. Furthermore, the appearance of the nose may confer internal and external perceptions of their gender, particularly in the transfeminine population.…”