Nose job

Besides the reduction of the Adam's apple, the feminizing rhinoplasty is probably the most common Facial Feminization Surgery procedure. After all, the nose is the most striking feature of the face. For many trans women, a rhinoplasty means a significant improvement in facial feminization. Refining the nose makes the eyes appear larger, the cheekbones stand out, and the face appears finer overall.

What makes a nose male or female?

Male nose

Bigger in every way.
The angle between the forehead and the nose is strongly pronounced.
The angle between nose and lip is less pronounced.

Feminine nose

Smaller in every way.
The angle between the forehead and the nose is more vertical.
The angle between nose and lip is more accentuated.

Male noses are usually larger than women's, with a wider nasal bone. Men also have a nose bump more often. Usually, female noses are smaller than men's in all respects. They are more likely to be narrow and straight or have a slight curvature, like a slide. The angle between the male forehead and the nose is sharper than in women and the angle between the nose and lip is also smaller (pointing more upwards). The angle between the nose and the lip is larger in women than in men. Women's nostrils also tend to be smaller.

Feminization of the nose

Standard rhinoplasty techniques can be used to reduce (or reshape) the nose and give it distinct feminine contours and proportions. The nose should be in harmony with the rest of the face. Feminization of the nose usually involves reducing the dorsum (bridge of the nose) and refining and lifting the tip of the nose. Reducing the brow bone creates a more beautiful angle between the nose and forehead. If the skin is thin, a significant reduction of the nose can generally be achieved. If the skin is quite thick (as is often the case in men), the contours of the nose can usually be refined, but there may be limitations to reducing the nose. Fortunately, simply changing the contours can make a nose appear much more feminine.

Procedure

General anesthesia—Feminization of the nose is usually performed under general anesthesia. Very occasionally this can be done under local anesthesia and sedation. The operation usually takes one to two hours.
Incision—During almost all rhinoplasty procedures, we prefer the “open method” because it gives the surgeon more room to work. In this 'open' approach, a small incision is made outside in the skin between the nostrils. After a few months, the scar is generally virtually invisible.

The operation itself—Depending on your wishes, the following options can be undertaken:
- Providing support to the tip—A piece of cartilage is taken from the septum or ear and placed between the nostrils to support the tip of the nose.
- Tip refinement—Sutures are placed to narrow the tip of the nose.
- Profile Shaping—The bone/cartilage bump is removed. The bump is often 'smoothed out' with the use of a surgical file or rasp to achieve a more accurate result.
- Reconstruction rhinoplasty—If the nose does not have cartilage to shape the tip, wings, or vault of the nose, cartilage can be taken from the septum or ear (or both). The cartilage is then shaped and inserted where the nose needs support. If larger volumes are required to enlarge the bridge of the nose, Mersilene mesh can be used for this purpose.
- Narrowing of the nasal bone—If the bridge of the nose is wide, it can be narrowed by breaking the nasal bone on both sides and bringing it closer to the center.
- Narrowing of the nostrils—The size of the nostrils can be reduced by narrowing the base of the nose.
Sutures—The incisions will be closed with small sutures. The stitches do not dissolve on their own and will need to be removed 8 days after the operation.

Recovery

Vaseline—Crusts should not form in the nose as this is not good for the healing process. The scabs that form must be removed. Applying Vaseline 3 times a day will soften the scabs so you can gently remove them (see video below).
Breathing—Most people find it very annoying that they can no longer breathe through their nose after rhinoplasty. During the pre-operative consultation we will provide you with nasal drops to reopen the nose after the operation.
Sutures—The sutures under the nose are placed 7 days after surgery by Dr. Bart van de Ven (or a nurse) removed.
Bleeding—During the first few weeks, sporadic bleeding may occur. This is normal and should not be a cause for concern.
Bruises—Most people experience bruising around the eyes and cheeks. The bruises under the eyes will worsen for two or three days before they begin to disappear. 15 days later, only you and your surgeon will be able to notice the traces of the operation.
Results—Your nose will soon return to its normal appearance, but you won't fully notice the final results of your rhinoplasty until six months later. The tip is the area that will take the longest to get its new, final shape.