Nose
Gender Differences:
In the front view, you can see that the feminine nose is narrower with smaller, less flared nostrils. In the profile view you can see that the feminine nose is smaller, the base is tilted upwards more and it has a shorter, blunter tip than the masculine nose. It also has slightly less of a hump.
Surgical Options:
Rhinoplasty is a big subject and it would take a whole book to get into every rhinoplasty technique that might play a part in feminising a nose - basically, it's pretty much all of them, but I will go over some of the key issues here.
1. Size:
Men typically have larger noses than women, so a feminising rhinoplasty
often involves making the nose smaller overall. Sometimes, that's the only
change you need to make if the overall shape is already feminine.
2. Removing a hump:
Having a hump to your nose is not technically a masculinity, but removing
it will often have a feminising effect. Think of a humped nose as "gender
neutral" - lots of women have them, and so do lots of men. However, the
hump is a little stronger in men, so reducing it has a feminising effect
and you can keep going until it is gone altogether, or even beyond that to
a scooped bridge, but see the questions section below for more on that.
3. Narrowing the nostrils:
This is called "alarplasty" and is quite a common procedure in feminising
rhinoplasty because men typically have wider nostrils than woman. A small
narrowing can often be done with incisions inside the nose where the scars
won't be visible, but larger reductions can involve external incisions
along the edge of the nostril. This will leave visible scars so it needs
very careful consideration. In my opinion, in most cases, a subtle
narrowing without scars is better than a strong narrowing with scars, but
if you are not at all bothered by visible scarring, you may feel
differently.
4. Lifting the tip:
If you look at noses from the side, and look at the angle between the base
of the nose and the face, you will see that masculine noses tend to come
out of the face at more of a right-angle, and feminine nose tend to be
angled upwards more. Creating this upwards angle is one of the key
procedures in feminising rhinoplasty.
5. Thick skin:
This is an important issue in rhinoplasty, and skin thickness varies a lot
from person to person, and from ethnicity to ethnicity. If your skin is
very thick, then it can hide a lot of the changes you make to the
underlying structure during rhinoplasty, and this obviously puts a limit
on the amount of change you can make. In fact, in a patient with very
thick skin, even a very drastic reduction of the underlying cartilage,
might make hardly any difference to the outward appearance.
There are ways to thin the skin, but this is something you need to consider very carefully because it can increase the risk of complications. It's also quite limited in the degree of thinning you can achieve.
6. Visible columellas:
The columella is the bit between your nostrils and on some people it is
very visible from the side. This is not a gender issue, it's purely a
beauty issue (and therefore completely subjective) but I am including it
here because it is quite often dealt with at the same time as feminising
rhinoplasty.
Basically, there are 3 reasons why your columella is more exposed than average - the first is that it hangs lower than normal, the second is that it doesn't hang low, but that the nostrils are higher than average, and the third is when you have a low columella and high nostrils at the same time. The columella can be lifted if necessary, and nostrils can be lowered with an "alar rim graft" so all 3 situations are fixable in most cases.
7. Straightening:
This is also not really feminisation, but again, people who have noses
that aren't straight, will often ask the surgeon to straighten them during
a feminising rhinoplasty. This can involve all sorts of techniques, but
the key thing to understand is that it's not always possible to completely
straighten a nose. You can certainly expect an improvement, but don't
expect perfect symmetry. Also remember that some nose asymmetry is normal
(no one has a perfectly symmetrical face).
8. Breathing problems:
Again, not feminisation, but if you do have a problem with the airflow
through your nose, it may be possible for the surgeon to correct this
during rhinoplasty depending on the nature of the problem and the
particular techniques the surgeon can perform, so don't hesitate to talk
to them about it.
Some Questions:
Can you do forehead and nose
separately?
You might have heard people (including some surgeons) say that it
is impossible to feminise the forehead without doing the nose at the same
time. This is only sometimes true, and there are patients who do not need
rhinoplasty at all, and others who need rhinoplasty but no forehead work.
In some cases though, you simply can't separate the procedures without
making compromises - like not fully removing the bossing, or only doing a
limited rhinoplasty.
It generally depends on the area where your nose meets the forehead which is called the "nasion" (also called the "radix"). If this area sits very far forwards of your eyes, then trying to reduce the nose down to an ideal feminine size, would leave an overhanging step where the forehead meets the new, smaller nose. Similarly, if you tried to fully feminise the forehead in a case like this without doing the nose, you would have a step where the forehead met the nose - basically because the nose is too big for the new forehead.
Which is better - a straight
nose or slightly scooped nose?
Many trans women want a small, scooped and turned-up nose as it is widely
believed that this is the most feminine nose shape. That is probably true
to some degree but it misses an important point - little turned-up noses
do not suit all facial types. I find they tend to look more natural on
shorter rounder faces (though there are always exceptions). On long faces
they can look a little unnatural and as many trans women have relatively
long faces (even after FFS) a little turned up nose may not be a good
choice. For these faces, a straight bridge can look more natural.
This seems to contradict what I said above about how removing the hump increases femininity, but this illustrates that sometimes you have to hold back a little if you want to keep an overall harmony and balance to the face.
Can I keep my family nose
shape?
In theory, yes, but there can be problems with this in feminisation.
Essentially, if the women in your family tend to have large/humped/wide
and/or otherwise masculine noses, then keeping that familial nose is going
to impact on the degree of feminisation you can achieve.
My overall philosophy is that feminisation is about removing the masculinities that happened to your face at puberty to take it back to it's original feminine structure (male and female children's faces are more or less identical, but the male face changes at puberty). I call this concept "puberty reset". However, this is one of the few areas where it can be advantageous to break the rule, and give yourself a nose that makes your face look more feminine than it would look with the family nose. It's not quite the nose shape you would have had without a male puberty, but it can help to compensate for other physical masculinities you might have as a trans women. This can be a very difficult decision to make and there's not always a right or wrong answer.
Is it easy to revise a
rhinoplasty?
Revision rhinoplasty is always more difficult than primary rhinoplasty.
This is because rhinoplasty (and all surgery) causes scar tissue. When the
surgeon goes back in to do a revision, they have to contend with the added
problems caused by the scar tissue from the first surgery. This second
surgery then creates even more scarring, so rhinoplasty not only gets more
difficult every time you go back in, but the complication rate rises too.
Is ethnicity an important
factor?
Noses vary a great deal between different ethnicities and it is generally
not a good idea to try to change the apparent ethnicity of a nose. If you
do, the result can look very unnatural and may involve making extreme
changes that can compromise function. For example I do not recommend trying to make a broad, flat,
typically African nose into a narrow, pointed, typically European nose. You can read more about this on my "Ethnic Variations" page.
Is it true that rhinoplasty
has the lowest satisfaction rates?
Yes, rhinoplasty does have somewhat lower satisfaction rates than many
other types of facial surgery. It's a difficult procedure to get exactly
right, and it's a feature that people pay a lot of attention to on their
own faces,