Rhinoplasty is statistically seen as a top five male plastic surgery procedure. Most commonly these are younger men who desire changes in the shape of their nose or improvement in their breathing due to internal obstruction. While the technical aspects of a male rhinoplasty are not different than that of women, there are numerous psychological and treatment planning issues that need to be considered.
While the exact percentage is not precisely known, the majority of rhinoplasty surgeries done in men are in the younger age range. From teenager up to the early forties would capture nearly 90% of all male patients. For a variety of reasons, the male rhinoplasty has historically been considered a challenging and hard to please patient. This younger age range has much to do with that as one’s self-image and social integration is being formed or challenged. While this is the same age range that women have the procedure, they are not nearly as difficult to manage. Men tend to be less patient, more critical and quickly assertive when things are not going as they envision it to be. Men are more likely to appear with nose drawings, analysis and pictures of model noses they would like to have. To say that some men may not be realistic in their expectations is not an unfair assessment. Thorough preoperative discussions with computer imaging is important. It is just, if not more important, to review what is not possible than what can be achieved.
The male rhinoplasty patient frequently wants or considers other structural facial procedures. While the nose can be the only facial structure they are interested in changing, frequently the younger man is looking for overall facial restructuring as well. Whether it is a stronger chin or jawline enhancement or higher more prominent cheek bones, many men are striving for a more defined angular or chiseled face. When considering numerous facial structural changes, it is imperative that presurgical imaging is done. When the number of facial structural changes exceeds two or more, it can be difficult to hit the their ideal aesthetic goals. Men need to be aware of the high revision rate due to their desire for aesthetic adjustments of one or more of the altered facial areas.
From an aesthetic standpoint, there are distinct differences between the male and female rhinoplasty result. While some women may desire a much smaller or more upturned nose, men do not. They want and look better with a well proportioned but a strong and straight nasal profile. This translates into a straight dorsal line profile that avoids over-resection of the dorsal hump area and no hint of any saddlenose shape. A higher dorsal profile, including the radix area, is important. The nasal tip should not be overly shortened. A recent study has shown that a nasolabial angle that is no more than 90 to 95 degrees is better for men compared to 95 to 105 degrees for women. This supports the need to avoid over rotating the tip upward. Over rotation may also create alar rim retraction and increased nostril show, a very undesired appearance in a man. Similarly, the tip often needs to be narrowed but a pinched or unitip appearance in a male is unaesthetic.
Many men are generally intolerant of the recovery process from a rhinoplasty. I know of few plastic surgery procedures that take as long to get to the benefits phase as that of a rhinoplasty. Given that it sits on the front of your face and seeing it constantly does not help. Most men have thicker nasal skin than women which translates into more swelling and a longer time to see the final results. Thick skin also can limit how much nasal definition can be achieved, particularly in the tip area. While the early use of tapes and a splint help control gross nasal swelling, some rebound swelling will occur after they are removed over the next few weeks. This is why men feel that the nose often looks a little more swollen a month after surgery than it did right after the tapes and splint were removed. The common phrase that it takes six months to a year after a rhinoplasty to see the final result is particularly true in men.
The challenges of a male rhinoplasty is in the before and after management, not the technical execution of the procedure in most cases. Discussing realistic expectations, having a tolerance of a longer than expected recovery, and understanding that the need for revisional surgery is common, will help the male patient have a satisfactory rhinoplasty outcome and experience.
Dr. Barry Eppley
Indianapolis, Indiana