Enhancing Masculine Appeal: The Art of Male Rhinoplasty
About 8% of aesthetic procedures are performed on male patients according to statistics by the American Society of Plastic Surgery.(1) Rhinoplasty is among the most popular operations in Plastic Surgery, and also for many men an area of their greatest concern. Given the stigmata with aesthetic surgery for male patients, it can sometimes be more challenging to articulate their goals and needs. Men might report primarily functional problems with the nose and will mention a possible aesthetic refinement on a side note. However, it is important to break down the barrier and create an atmosphere of trust so that goals and expectations can be reliably discussed. One priority I often hear when talking to male patients is to not feminize the nose and to maintain their masculinity. Obviously, for any male patient wanting to undergo transition surgery that will be the opposite.
How does male facial anatomy differ from female anatomy?
Men in general tend to have square faces with broader features. The nasal dorsum in men tends to be wider, and the dorsal aesthetic lines of the nose are often less defined than in women. From a lateral view, the dorsum is straighter, meaning that a line from the radix to the tip-defining points signifies the ideal location of the dorsum.
Men often do no desire a slope or a supratip break, which are considered feminine characteristics. The male nose is typically longer than the female nose and has thicker skin. The ideal male nose has a higher nasion and straight profile relative to the female nose. Men often prefer a more angular nasal tip instead of a round nasal tip which appears softer and also more feminine.
Another important feature for the appearance of noses is the relationship to the chin. A set back chin will make a nose appear longer and larger while a very prominent chin will set the nose back and make it appear smaller. Male chins tend to be more prominent and project to the vermilion of the upper lip. Men can camouflage a short chin or upper lip abnormalities with facial hair.
Most other men regardless of ethnicity found a nasolabial angle
of 90 degrees to be the most aesthetically pleasing. In comparison women often prefer a more rotated or upturned nose with an angle on 100-105 degrees. One of the goals in male rhinoplasty is achieving strong tip projection along with a straight dorsum.
How age can influence the appearance of a male nose
Another feature that can play an important role in the desired appearance of a nose is the patient’s age. While rotated noses often make the face look younger a more angular or even down-rotated nose will make the face look older and more stern. In one population analysis study, older men tended to prefer noses with larger, more obtuse nasolabial angles (>100 degrees) in comparison with younger men. In older men, the skin and soft tissue lose elasticity and there is sebaceous hyperplasia that can lead to tip ptosis.
Features of the young and old male nose
What happens during consultation for male rhinoplasty
As with any patient seeking aesthetic counsel, the patient’s motivation for surgery is the first thing that needs to be evaluated. Next to a thorough history the exam plays a key role. As in any rhinoplasty, the facial analysis is the most important step in determining a surgical plan. Only when the deformities are diagnosed accurately can a suitable surgical plan be formulated. And only if irregularities and patients complaints match up will the end result likely be a success.
What is the right technique for male rhinoplasty?
The goal in male rhinoplasty is to make
changes that address the patient’s concerns, but
any extreme change could alter the patient’s natural
appearance or feminize the nose. Another
important principle is not to oversculpt the nose,
which is a telltale sign of a rhinoplasty. As with
other rhinoplasties, many of the typically defined
techniques can be utilized in a male rhinoplasty.
The three most common issues in men are a
prominent dorsal hump, wide nasal bones, and
poor definition of the tip.
Technical Aspects for Male Rhinoplasty
Tip Refinement
Dorsal Hump Reduction versus Dorsal augmentation
Osteotomies
Factors to Be Assessed in Male Revision Rhinoplasty Patients
Open roof deformity
Concavity or convexity of dorsum
High or deep radix
Narrow middle vault
Inverted-V deformity
Pollybeak deformity
Tip rotation
Tip support
Overresection of lower lateral cartilages
Infratip lobule excess
Ptotic tip
Deviated septum
Breathing difficulty (internal or external nasal valve constriction
or collapse)
Revision male rhinoplasty
Male revision rhinoplasty might come with an additional set of issues. In male patients desiring revision rhinoplasty, the most common reasons for dissatisfaction are a residual dorsal hump, underrotated tip, and a small nose.
Postoperative Care for Male Rhinoplasty Patients
Postoperative care is the same as for female patients and mainly will include a prescription for an antibiotic, steroids, pain medication and nasal spray. Patients should keep the head of the bed elevated and follow sinus precautions in the early recovery period. Ice packs can be applied as needed the first 2 days after surgery. Splint and sutures will be removed after one week.
Male Skin Care Will Impact Rhinoplasty Results
Skin care is an essential component to optimize any surgical result, especially in men. In general, men may not be interested in skin care,
but male patients undergoing rhinoplasty should be educated on the importance and benefits of skin care. The essentials of a skin care regimen
include moisturizing, application of sunscreen, and treatment of any skin conditions, such as acne. In men, the skin has greater hair distribution,
decreased skin pH, and greater sweat production.45 After rhinoplasty, pores on nasal skin can enlarge and greater sebum is produced,
so skin care is important in obtaining an optimal surgical result. Men who are prone to acne should avoid comedogenic products, whereas men with sensitive skin should use fragrancefree products.
References
1. Simons RL, Adelson RT. Rhinoplasty in male patients. Facial Plast Surg. 2005;21:240–249.
2. Winkler AA, Downs BW. Aging male rhinoplasty. Facial Plast Surg Clin North Am. 2008;16:329–335, vi.
3. Wright MR. The male aesthetic patient. Arch Otolaryngol Head Neck Surg. 1987;113:724–727.
4. Toriumi DM, Rosenberger E. Rhinoplasty of the aging nose. Facial Plast Surg. 2016;32:59–69.
5. Etöz BC, Etöz A, Ercan I. Nasal shapes and related differences in nostril forms: A morphometric analysis in young
adults. J Craniofac Surg. 2008;19:1402–1408.
6. Rohrich RJ, Janis JE, Gunter JP. Male rhinoplasty. In: Gunter JP, Rohrich RJ, Adams WP Jr, eds. Dallas Rhinoplasty: Nasal Surgery by the Masters. 2nd ed. St. Louis: Quality Medical Publishing; 2007:1281--1304. Surg. 2008;122:1229–1241.
7. Schlessinger J. Skin care for men and its marketing. Dermatol Ther. 2007;20:452–456.
8. Draelos ZD. Male skin and ingredients relevant to male skin care. Br J Dermatol. 2012;166(suppl 1):13–16.
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