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Rhinoplasty is a common facial masculinization procedure given that there are major gender differences in the shape of the nose. A masculine nose typically has a straight or even slightly convex dorsal line in side profile. It also has a nasal tip that is not overly narrow and a nasolabial angle that is at 95 degrees or less. Some artists even describe the male nose as being more sharp and chiseled in shape. (works well in drawings and caricature rendering, no so sure that translates to a surgical goal)  To achieve these changes in a nose that has distinctly feminine characteristics requires dorsal augmentation and tip derotation/lengthening. In some cases a wider bridge or tip area may also be desired.

If the only nasal change needed is to increase the height of the bridge, this can be done through a variety of dorsal augmentation techniques. The debate is always which augmentation method is to be used which comes down to a cartilage graft (usually rib) vs an implant. Each has their advantages and disadvantages which are well known and both techniques can be very effective. Rb grafts have the benefits of not being an implant but shaping it and preventing it from warping after surgery are its challenges. Dicing the rib graft and wrapping it in fascia overcomes these issues.

Implants have the advantage of not having to be harvested and comes with an assured shape. The key with implants in the nose is to use an implant layered or totally made of ePTFE. (expanded polytetrafluroethylene) This material allows for tissue adherence and has less risk of complications in the nose than a pure silicone implant.

Controlled changes in the tip of the nose require cartilage grafts for bringing the tip down (derotation) as well as to widen it if needed. Such cartilage grafts are usually harvested from the septum where concurrent septal straightening/inferior turbinate reduction can be done to improve nasal airflow if needed.  If the combination of dorsal augmentation and tip lengthening/derotation are the rhinoplasty changes needed then the volume of graft supplied by rib cartilage is needed.

Dr. Barry Eppley

Indianapolis, Indiana

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