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

Abstract

IMPORTANCETogether 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. RESULTSIn 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 RELEVANCEIn 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.

Current State of Transgender Medical Education in the United States and Canada: Update to a Scoping Review

“…Results of our gray literature search included 15 online continuing medical education (CME) courses from 7 professional organizations, in the form of online articles and videos (Table 2). 10-12,26-37…”

Feminizing the Face: Combination of Frontal Bone Reduction and Reduction Rhinoplasty

“…While the middle and lower thirds of the nose can be addressed without any concurrent operations, the radix and nasofrontal angle are more difficult to control without also altering the glabella and brow region. While a deep radix can be augmented and the nasofrontal angle softened via rhinoplasty alone, creation of a significantly widened nasofrontal angle can only be achieved with frontal bone reduction in combination with rhinoplasty [17]. We believe that, based on our operative experience, concurrent nasal and frontal bone feminization is not only safe but also a more powerful and convenient technique.…”

Feminização, estigma e o gênero facializado: a construção moral do gênero feminino por meio de cirurgias de feminização facial para travestis e mulheres transexuais

“…Escrever isso me faz chorar. (Cox, 2011) A tônica racial da rinoplastia esteve presente em recente controvérsia: em artigo publicado pela equipe da Facialteam no periódico Jama Facial Plastic Surgery, Bellinga et al (2017) descreveram cirurgicamente a técnica da rinoplastia no processo de feminização facial, porém sem maiores discussões sobre as implicações sociais de tais procedimentos. Isto foi matéria de crítica de Jeffrey Spiegel (2017) em comentário encomendado e presente no mesmo número do periódico, o qual questionava a naturalização de um único ideal de beleza no próprio procedimento técnico das cirurgias plásticas, em especial a rinoplastia e a "feminização" de caracteres faciais.…”

“…Em suas palavras, "embora essas medidas [ (Spiegel, 2017, p. 181, tradução minha). Cho, Massie e Morrison (2017) reiteraram tal crítica em carta publicada no mesmo periódico, destacando que as medidas para o nariz que Bellinga et al (2017) apresentaram em seu artigo correspondem a um nariz branco e não à diversidade de tipos de narizes possivelmente encontrados em potenciais clientes/ pacientes. Em seu direito de resposta, os primeiros autores afirmaram que consideravam a validade de tais críticas, porém acima de qualquer normalização étnica do nariz, a cirurgia de feminização facial na qual a rinoplastia está incluída leva conjuntamente em consideração "as preferências estéticas da paciente, características antropométricas, idade, etnia, sexo e a relação harmônica entre os terços faciais" Simon, 2017, p. 243).…”