Impact of Gender-Affirming Rhinoplasty Techniques on Objective Facial Appearance.

[OBJECTIVES] To evaluate the impact of transfemale gender-affirming rhinoplasty on nasal appearance as evaluated by common facial analysis measures.

[METHODS] Retrospective case series of patients undergoing gender-affirming nasal surgery at a single tertiary care center from March 2016 to July 2022. Pre- and postoperative photographs were analyzed, using iris width to normalize the measurements. Parametric tests were applied to identify differences in facial analytical measures.

[RESULTS] A total of 33 male to female transgender patients met the inclusion criteria for study entry. Reductive rhinoplasty techniques were frequently utilized. Osteotomies and dorsal reduction were performed in 90.9% and 72.7% of cases, respectively. Tip width decreased on average by 2.3 mm. There was a mean increase of 10.0° in nasolabial angle, and 5.5° increase in nasofrontal angle. Among the 51.5% of patients who underwent alar base reduction, there was a mean decrease of 2.3 mm in alar base width, and 3.1 mm decrease in nasal width. Alar base excision and nasal tip grafting were utilized in 51.5% and 63.6% cases respectively.

[CONCLUSIONS] Transfemale gender-affirming rhinoplasty techniques consistently and predictably altered facial analytical measures, and were effective in aligning nasal appearance with desired gender identity. Alar base excision and tip grafting were commonly employed techniques.

[LEVEL OF EVIDENCE] 4-Quantitative cohort study Laryngoscope, 135:1691-1696, 2025.