Why gender-affirming rhinoplasty is done

Rhinoplasty is one of the most common plastic surgery procedures done in the United States, year after year. Improving nasal breathing and appearance at the same time can have a huge impact on someone’s quality of life. Furthermore, altering facial features to progress gender congruence may help to reduce gender dysphoria symptoms, as well as improve overall quality of life for trans-identifying individuals.

Though a common surgery, Rhinoplasty has changed significantly in understanding over the years. Our facial plastic surgeon experts focus on both the form and function of the nose, not sacrificing one for the other. Using the most up to date techniques, we strive to give the best long-term results for one of the most challenging surgeries in the field.

Rhinoplasty isn't for everyone. Your doctor might caution against surgery if you:

  • Have a significant history of prior nasal surgery
  • Have a severe chronic condition, such as heart disease, autoimmune disorders, or diabetes
  • Have a body mass index that's greater than 35
  • Have severe sleep apnea
  • Are a smoker

Risks of rhinoplasty

  • Nasal obstruction. Though rhinoplasty is often used to improve nasal breathing, alterations in nasal size could lead to airway narrowing. To reduce this risk, our facial plastic specialists employ the most up to date techniques to improve appearance without sacrificing function or structure.
  • Swelling/bruising. Significant swelling or bruising is likely to develop after the procedure. This may affect the eyes/eyelids and progress down the face and neck. Most swelling and bruising are expected to resolve within 3-4 weeks of the procedure, however final nasal appearance results will often take 1-2 years (very subtle after 3-4 months).
  • Failure to achieve desired result. Patients may not notice the improvement they were hoping. Counseling on realistic expectations is imperative prior to undergoing surgery. Ask your surgeon if simulation is available at their office, which can help predict possible outcomes.
  • Need for additional procedures. Revisions are uncommon, but occasionally necessary, for some patients.
  • Changes in skin sensation. During “open” rhinoplasty, the elevation of tissues can affect the nerves, especially in the nasal tip region. You'll likely feel some reduced sensation or numbness that can take up to one year to resolve.

What to expect

  • Before the procedure you will have a consultation with your surgeon where you will come up with an individualized plan, as well as have a discussion of expectations. Pictures will be obtained from various views for planning as well as comparison following the procedure.
  • During the procedure you will be fully asleep (general anesthesia). Typically, incisions are made under the nose and inside the nostrils to be as camouflaged as possible. Sometimes the nasal bones are reset to improve the overall appearance of the nose. The incisions will be closed with sutures and often packing, or splinting, will be placed inside the nose to assist healing.
  • After the procedure it will be important to remain upright as much as possible to help reduce swelling and bruising. An external nasal dressing is typically placed to provide protection and reduce swelling. Some blood-tinged secretions from the nose are expected following the procedure. You will often be asked to avoid nose-blowing for a period of time to allow proper healing and prevent complications. You may be prescribed antibiotics and narcotic pain medication for comfort. Ice therapy will typically be recommended to help reduce swelling.

Results

Approximately one week after surgery you will visit the office to remove external dressings, sutures and/or splinting. While breathing may already be improved after that visit, please allow 3-4 weeks for nasal sensation to return before judging results. Most patients are happy with the appearance in 3-4 weeks, “studio-ready” in about 3-4 months, with final appearance results in about 1-2 years after surgery. The majority of swelling settles into the nasal tip, which requires significant patience for it to fully resolve.

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