Rhinoplasty (nose job)

Rhinoplasty (nose job)

Aside from the trachea shave, nose reshaping is probably the most common facial feminisation procedure. The nose is the most prominent feature of the face. Many transwomen reckon that nasal refinement can create marked improvements in their female facial appearance. It tends to make the eyes look larger, bring out the cheekbones and it adds delicacy to the overall facial impression.

FAQs about this procedure

Gender of the nose

Male nose

  • Bigger in all aspects.
  • Angle between the male forehead and nose is strongly pronounced.
  • Angle between nose and lip is less pronounced.

Female nose

  • Smaller in all aspects.
  • Angle between the female forehead and nose is more vertical.
  • Angle between nose and lip is more accentuated.

Male noses are usually larger than those of women, with a broader nasal bone. Men more often have a nasal hump. Usually, beautiful female noses are smaller than those of men, in all aspects. They tend to be narrow and straight, or to have a gentle curvature like a slide.
The angle between the male forehead and nose is sharper than in women and the angle between the nose and lip is also smaller (more pointing upwards). The angle between the nose and the lip is bigger in women than in men. Women´s nostrils are usually smaller as well.

Feminizing the nose

Standard rhinoplasty techniques can be used to make the nose smaller and to give it clear feminine outline and proportions, taking into consideration that it should be harmonious with the rest of the face.
In a reduction rhinoplasty, generally the dorsum and tip of the nose need to be made smaller and the tip lifted. Correction of the frontal bossing will improve the angle between the nose and the forehead.
If one has thin skin, a significant reduction can generally be completed. If the skin is quite thick (as is often the case in males), the contour can still be markedly improved, but there may be a definite limitation to the size reduction possible. However, contour changing alone greatly feminizes the basic nasal appearance.

Procedure rhinoplasty

Click here for a more in depth description of the rhinoplasty procedure.

  • General anesthesia—Rhinoplasties are usually done under general anesthesia. In certain minor cases, local anesthesia and sedation may be used. The operation generally lasts between one and two hours.
  • Incision—For almost all rhinoplasties we prefer the ‘open method’ because it gives the surgeon more operational space. In the ‘open’ approach one small incision is outside the nose across the columella (the skin between the nostrils). After a couple of months the scar is generally extremely difficult to see.
    Incision for an open rhinoplasty
  • The real job—According to your individual needs following actions may be done:
    • Giving support to the tip— A cartilage ‘strut’ is taken from the septum or ear and sutured into the columella (part of the nose between the nostrils) to give support to the nasal tip.
    • Refining the tip—  Sutures are placed to achieve refinement or ‘narrowing’ of the nasal tip.
    • Shaping the profile—The bone-cartilage hump is removed. A surgical file or rasp is commonly used to smooth the bony hump, in order to achieve more precise results.
    • Reconstruction rhinoplasty— In case the nose structurally lacks cartilage to give shape to the tip, the wings or the vault of the nose, cartilage may be taken from the septum, or ear(s) reshaped and sutured in place in the part of the nose that needed support. Of larger volumes are needed to augment the dorsum a roll of Mersilene mesh is a good option.
    • Narrowing the nasal bone— If the bridge of the nose is wide, it can be narrowed by fracturing the nasal bone on each side and moving it closer to the centre.
    • Narrowing the nostrils— The volume of the nostrils can be reduced by an alar base excision
  • Sutures—Small sutures will be used to close the incisions. The sutures are not absorbable, and have to be removed 8 days after the surgery.
  • Nose cast—A nose cast will be put on your nose to keep the bones and cartilages in their proper position and prevent fluid collecting between skin and the underlying cartilages that may lead to scar tissue which degrades the quality of the final result of the rhinoplasty.

     

Recovery and aftercare after rhinoplasty

  • Nose cast—A nose cast is placed on your nose and fixed with tape. It should stay on the nose for one week.
  • Vaseline—No crust may be formed in the nose as this is not good for healing. The crust have to be removed. Vaseline 3 times a day helps to soften the crusts so you can remove them gently (see video below).
  • Breathing— Most people find it very difficult not being able to breathe through their noses after the rhinoplasty. We will give you some nose drops to open up the nose during your preoperative consultation.
  • Stiches—The stitches underneath the nose will be removed by Dr Bart van de Ven 7 days after the surgery.
  • Bleeding—Some sporadic bleeding could be expected during the first couple of weeks, which is normal and should not be a cause of concern.
  • Bruising— Most people get bruising around the eyes and cheeks. The bruises under the eyes will intensify during two or three days before they begin to vanish. 15 days later, only you and your surgeon will be able to notice any traces of the surgery.
  • Appearance—Your nose will regain its normal appearance very soon, but the definitive results of the rhinoplasty will be fully appreciated after six months. The tip is the area that takes the longest to acquire its new shape.

FAQ

FAQs before surgery

Sometimes I get asked to model during a photoshoot. How long should I wait to book one after my FFS?

That is a very difficult one. It depends very much upon your healing and we can’t give you any guarantee about how long it takes before you look good enough for a photoshoot.
It could be 4 months, but it could also be a year. Of course it also depends on the amount of work that has been done.

What does this procedure cost?

If you want you can send us good pictures together with your ideas so we can send you a financial and operative proposal. To receive a proposal, please fill in the proposal request online and pay the proposal fee of 50 euro through Paypal.

Of course you are always welcome for a consultation.

Could breathing be more difficult after a reduction rhinoplasty?

In a normal nose the respiratory route is critical at just one point which is the internal valve. By the use of spreader flaps or spreader grafts Dr van de Ven will make sure that there the nose doesn’t become smaller.

How often is revision surgery necessary after a rhinoplasty?

Rhinoplasty is considered to be an operation with high risks, primarily because of the limited predictability of the aesthetic result. Postoperative deformities are considered as main risks of rhinoplasty, causing revision surgery in 5% to 15% of the cases. What are the reasons? A perfect result immediately after surgery may be totally different one year later. Limited predictability is mainly due to the dynamics of the healing process. Many different types of tissues are involved: bone, cartilage, mucosa, skin, fat, fascia, muscles, nerves, vessels, perichondrium and periosteum. The individual reactions of these tissues are not always under the control of the surgeon. This is especially true for cartilage, the main supporting structure of the nose.

The risks for rhinoplasty-complications can be reduced with increasing experience. A prerequisite is continuing education and an earnest distinction between complication and mistake. Dr Bart van de Ven has build up a decent experience with noses during his carrier. To help the healing process he developed a device called ‘nose moulder’ that drastically decreases some of the aesthetic complications after rhinoplasty. Because of the real pressure possible with this splint less fluid collection between skin and underlying tissue is the result. Fluid can be replaced by the body by scar tissue, compromising the aesthetic result. The real pressure also gives a real fixation of the bone cuts. This results in significant straighter noses.
test

FAQs after surgery

How long should I wear the nose moulder?

You should try to wear the nose moulder as much as possible during the first 3 weeks after surgery. Please make sure the nose moulder is placed in the middle. If it hurts you should make the elastic band wider and/or leave the nose moulder completely off for a while.
After the first 3 weeks we advise to wear the nose moulder every night until the check-up 4 months after the surgery.

How long should I wait to see the final result of a rhinoplasty?

After a rhinoplasty you have to be really patient. During the first 3 months it can be very swollen. Especially if you have a thick type of skin it can take more than a year for all the swelling to disappear. The nose can continue to change until 1 – 2 years after surgery.

Would it help my nose swelling if I put some tape across it?

The tape helps partly to avoid the swelling from forming. Once the swelling is there, the tape will not let is disappear. Only waiting….Also the nose moulder is not useful for the swelling, this is only to keep the nosebones in place.

You still have another question? Feel free to ask! We will answer your question and if generally applicable add it to the FAQ of this page.