Focus on facial harmonization with rhinoplasty for facial feminization
Patients seeking facial feminization surgery, particularly male-to-female transgender patients, reported high satisfaction with the results of rhinoplasty combined with lip-lift and forehead reconstruction, according to study results published in JAMA Facial and Plastic Surgery.
The researchers reviewed 200 feminization rhinoplasties they had performed in male-to-female transgender patients between Jan. 11, 2010, and May 29, 2015. The procedures were often performed in combination with forehead reconstruction (n = 150), lip-lift (n = 24) or both (n = 21). Five patients underwent only rhinoplasty.
“When a lip-lift is performed simultaneously with the rhinoplasty, the same incision is used for both, with the skin fully lifted from the columella to expose the medial crura of the lower lateral cartilages,” Raúl J. Bellinga, MD, FEBOMS, and colleagues wrote. “Although this procedure is technically more laborious and requires a more meticulous dissection, it negates the need for a new columellar incision, which could compromise the viability of the cutaneous cover between the two incisions.”
The procedures focused on refinement of the tip, feminization of the profile, shortening the nose and narrowing the nasal bone, The patient’s own cartilage was used for structural grafts. The surgeons avoid bank cartilage or alloplastic materials as they have a record of long-term complications, such as infection, implant displacement, protrusions, cutaneous problems and contractions.
“When the facial feminization surgeon addresses only the aesthetic problems of the nose without considering the nose’s inner structure and support, midterm and long-term complications can occur, such as asymmetry, deviation, or tip collapse,” the researchers wrote.
The mean frontonasal angle changed from 133.64° to 149.08° (difference in means, 15.44; 95% CI, 17.12 to 13.76; P < .001). A majority of the patients rated their satisfaction with the outcomes as 4 out of 5 points on the Nose Feminization Scale, in which 1 indicates very masculine and 5 indicates very feminine or exceptional result. – by Talitha Bennett
Disclosure: The researchers report no relevant financial disclosures.