This is a good article on nose surgery in facial feminization. The authors performed nose surgery on 12 transgender patients between 1998 and 2004. Measurements after the operation showed that the noses were more feminine. Eleven of the patients were very satisfied. One patient was unhappy with the results and had revision surgery. “Five patients stated at the 1-year visit that their nasal procedure had had one of the greatest impacts on their overall perception of themselves as female.”
Care needs to be taken to make sure the nose works after the surgery.
Although the basic techniques of nasal feminization surgery are not inherently different from rhinoplasty in general, the extensive tissue reductions often required potentially put the patient at risk of nasal valve insufficiency. Particular attention, therefore, must be paid to the preservation of nasal function. In our series, the nasal valve mechanism needed to be reconstructed in 4 patients, and there were no instances of nasal valve insufficiency in the postoperative period and at 1-year follow-up.
The authors discuss the differences between male and female noses and the surgical techniques they used to feminize the nose.
An interesting aspect of the study was that the patients chose not to do one particular procedure that would have made their noses more feminine. Just because a feature is more typically found in females does not mean that a trans woman wants to have it.
Independent observers evaluated photos of the noses and profiles before and after surgery. They found that surgery created a more feminine profile in all cases, based on measurements of the photographs.
The study does a good job of posing before and after pictures the same way, in fact, the hair in the before picture is slightly more feminine. You can clearly see that the nose is smaller.
As in other studies, it would be good to have information on whether the new nose helped the trans women to pass and whether any of them could pass before the surgery.
The study was done in the United Kingdom; the authors explain that before being diagnosed with transsexualism, the patient must live and dress as a woman for two years and have consulted a psychiatrist. The diagnosis is needed for gender reassignment surgery. Thus, the trans women in this study would have had considerable experience presenting as a woman before they had the surgery.
As in many studies, the authors are the people who did the surgery and who therefore may be biased in favor of believing it worked; however, they used independent observers to evaluate the appearance of the nose.
Overall, a good study, although the sample size is small. Future studies should address the question of whether nasal surgery helps trans women to pass and whether it improves their well-being and quality of life.
The Role of Nasal Feminization Rhinoplasty in Male-to-Female Gender Reassignment by S. A. Reza Nouraei, Prem Randhawa, Peter J. Andrews, Hesham A. Saleh in Arch Facial Plast Surg. 2007 Sep-Oct;9(5):318-20.