Nasal surgery appears to effectively create feminine facial profiles in patients undergoing male-to-female gender reassignment, according to a report in the September/October issue of Archives of Facial Plastic Surgery, one of the JAMA/Archives journals.

“Transsexualism is a recognized medical condition, with an estimated incidence of one in 37,000, in which the affected individuals strongly believe themselves to have been born into the body of the wrong sex,” the authors write as background information in the article. “Increasing acceptance of this condition as a medical disorder has led to the development of a number of medical and surgical approaches aimed at aligning the patient’s physical appearance with his or her perceived sex.”

S. A. Reza Noureai, M.B.B.Chir., and colleagues at Charing Cross Hospital, London, studied 12 patients who underwent rhinoplasty (plastic surgery on the nose) as part of male-to-female gender reassignment between 1998 and 2004. The surgery involves reducing the overall size of the nose and also changing nasal angles to more closely match those of female noses. Two independent observers assessed the participants’ facial profile before and after surgery and also measured specific facial angles. Patients’ nasal function was tested before and after surgery, and they were asked to rate their satisfaction on a five-point scale after the operation and again one year later.

“The surgical procedure resulted in a more feminine nasal profile in all patients,” the authors write. “One patient was subjectively unhappy with the results of surgery and underwent revision surgery, and the remaining patients were very satisfied with the results of surgical treatment, both in the early postoperative period and at the one-year follow-up visit. Five patients stated at the one-year visit that their nasal procedure had had one of the greatest impacts on their overall perception of themselves as female.” No patients had difficulty with nasal valve functioning.

“Rhinoplasty is effective in achieving feminine facial profiles in patients undergoing male-to-female gender reassignment,” they conclude. “This requires reducing the overall nasal size and changing nasal angles to those more reminiscent of the female form. Because of the extensive resections often required to modify the nasal form, it is important to pay particular attention to preserving function, which may require concomitant nasal valve reconstruction.”