There are major gender differences in the shape of the nose despite that nose shapes comes in a wide variety of shapes and sizes. In achieving a more feminine-looking nose the key is the shape of the dorsum (bridge) and the tip. A straight or preferably slightly concave dorsum with a tip that is narrow and with a nasolabial angle that is more open and of at least 110 degrees is preferred. Lowering the central dorsum to create a slight saddle appearance and having a significant tip rotation, and tip deprojection if necessary, has a very feminizing effect. Good tip rotation is important but should not be done so much that excessive nostril show occurs. Getting the radix of the nose lowered (height of the nose between the eyes) is a key feature and is best achieved when done at the same time as a brow bone reduction. (as coming from above is the easiest and most assured method of lowering it)
To some degree feminizing a nose potentially violates adequate support for the middle third of the nose and potential nasal airway compromise….if it is done aggressively which some patients prefer. But this can be avoided by adequate cartilage graft support.
An open rhinoplasty is usually needed to reliably achieve these nose shape changes. Because in most male to female rhinoplasties it is usually a reductive operation extensive cartilage grafting is not usually needed. But septal cartilage grafts for the columella to support the nasal tip and possibly the middle vault for nasal airway support are commonly used.
Dr. Barry Eppley
Indianapolis