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

Abstract

Background: Facial gender-affirming surgery encompasses a myriad of procedures ranging from skeletal to soft tissue maneuvers depending on the manifestation of dysphoria in individual patients. In this work, we reviewed techniques for feminizing rhinoplasty in a single center and performed a systematic review of the literature. Methods: A systematic literature review was performed in order to survey articles that discussed techniques and clinical considerations when performing rhinoplasty among transgender females and non-binary patients. In addition, a retrospective review of such patients undergoing rhinoplasty by the senior author. Variables collected included demographic factors, operative details, and post-operative events. Results: Initial review yielded 56 articles. Standardized application of inclusion and exclusion criteria resulted in a total of 12 studies. Priorities of feminizing rhinoplasty entail reduction of dorsal hump, as well as tip refinement and deprojection. Sixty-five patients were included for analysis. The majority of patients underwent rhinoplasty through an open approach (83%). For the dorsum, 89% received dorsal reduction and 80% underwent percutaneous osteotomies. For tip work, 37 (56.9%) received a septal caudal extension graft, while a minority of patients required columellar strut (25%) or tip graft (8%). For functional restoration, septoplasty (71%) and spreader flaps/grafts (58%) were utilized to correct internal valve collapse, while alar rim (8%) and alar crural strut (3%) grafts were performed to address external valve collapse. Complications included septal deviation, hypertrophic scar, and contour irregularity. Two patients required revision (3%). Conclusion: The core tenets of the operation lie in the reduction of the nose, tip deprojection and rotation, as well as the creation of harmony with other facial structures. Our multi-pronged analysis presents an updated review of these principles, as well as a longitudinal outlook on outcomes associated with feminizing rhinoplasty.