Surgical Management of the Nose in Relation With the Fronto-Orbital Area to Change and Feminize the Eyes' Expression

Gender affirmation surgeries in male-to-female transition patients include breast augmentation, genital construction, and facial feminization. Facial features serve an integral role in identifying an individual's gender, with certain characteristics perceived as feminine or masculine.The nose, as the centerpiece of the middle third of the face, is an important component of facial attractiveness and gender identity. Thus, reduction rhinoplasty is a mainstay of the facial feature remodeling (FFRS) and facial feminization surgery (FFS).The authors usually divide the surgery planning in 2 steps, obviously depending on each patient needs, but generally speaking, the authors do the upper part of the head in one stage and the mandible and face lift in another.If the patient only requires frontal bone surgery and softening of the orbital rims, the authors always perform the nose surgery in this stage. If a mandible reduction is needed, combined with a face-lift, the authors do it in another procedure, usually separated between 7 to 10 days from the other surgery. In these cases, the authors begin with the lower part of the face on the first stage and then, the frontal bone and rhinoplasty on the second.The fronto naso-orbital complex is one of the main facial areas that determine the identification of facial gender, the nose plays a crucial role in FFS of the middle third. The main goal of rhinoplasty in FFRS is to change masculine nasal features to feminine ones by performing dorsal reduction, tip refinement, and narrowing the nasal bones, most often using an external approach and cartilaginous grafts to provide good tip support and long-term stability. Lip-lift and frontonasal recontouring can be technically complementary to rhinoplasties associated with facial features remodeling and feminization.