Rhinoplasty and Facial Feminization: Which Comes First?

Like many people, transfeminine individuals often focus on their nose and might wonder if nose surgery (rhinoplasty) alone might be enough to give them the feminine appearance they are seeking.

It’s natural to want fast results so you can present your feminine self to the world as soon as possible. The masculine nose tends to be larger than that of a cisgender woman of similar size, so you might be tempted to rush into only having rhinoplasty or having rhinoplasty before facial feminization surgery (FFS). But a smaller feminine nose on a face that remains mostly masculine in appearance may not give you the natural feminine effect you were hoping for.

If you are considering rhinoplasty and FFS (facial feminization surgery) you will usually want to have both done at the same time

To give you the most natural result, your nose should be in harmony with your whole face. The question is: which face?

• Do you want your nose to look more feminine in the masculine face you have before FFS?
• Or, do you want your nose to be in harmony with the feminine face you will achieve after FFS?

Creating a feminine nose before FFS might make it difficult for your surgeon to create both a feminine nose and an appropriate transition between your forehead and nose. If you think you might have FFS in the future, having rhinoplasty first might also mean you will need a second rhinoplasty to ensure your nose harmonizes with your new feminine face.

To give the best results, we recommend you consider an integrated FFS plan before having rhinoplasty. That way, your new nose can be designed to harmonize with the aesthetics of your future feminine face.

We recommend rhinoplasty and FFS as either:

• A single long-format session to feminize the entire face, or,
• Two phases of surgery to harmonize related areas such as the upper face (forehead and nose) and lower face (chin and jaw) – these can be performed days, weeks, or even years apart.

Benefits of rhinoplasty performed at the same time as FFS

An essential element of the success of FFS is a nose that has a feminine size and shape and is in harmony with your final feminine face, with an appropriate aesthetic transition between the forehead and nose.

Simultaneous surgery on the forehead and nose enables the surgeon to have better control over the angle between the forehead and nose. Lip-lift techniques can also be performed at the same time to normalize the ratio of the length of your upper lip and the amount of tooth show we expect in a feminine profile.

The results of simultaneous upper face FFS speak for themselves. In a study of 200 people who had rhinoplasty in combination with forehead reconstruction and/or lip-lifting, the surgeon was able to achieve a good transition between forehead and nose and most clients were highly satisfied with the femininity of their nose after the surgery.

Disadvantages of rhinoplasty on its own, or before forehead feminization

Of course, FFS needs to take into consideration your individual situation and the features of your face.

The timing of the FFS procedures will impact your results. While up-front rhinoplasty might seem like a quick fix, there are some disadvantages:

• Your brow might look more prominent if you have rhinoplasty alone or before FFS.
• You might need additional rhinoplasty during a future forehead feminization procedure.
• Your first rhinoplasty will not be performed in the context of a full FFS design – it may not give the best result for your future face.

We recommend a consultation to fully understand all your options and to consider an overall FFS plan that will give you the best and most natural results.

Want to know more?

• Facial Feminization Surgery – A Complete Guide to FFS
• Facial Feminization Surgery – Overview
• Key Elements Of Facial Feminization For Women With Masculine-Looking Faces
• 5 Features That Can Make Your Face Look Masculine
• FAQs – Facial Feminization

References – for those who like to dig deeper

• Approach to Feminization Surgery and Facial Masculinization Surgery: Aesthetic Goals and Principles of Management. Deschamps-Braly JC. Journal of Craniofacial Surgery, 2019; Apr 2 [Epub ahead of print].
• Current Concepts in Feminizing Gender Surgery. Safa B, Lin WC, Salim AM, Deschamps-Braly JC, Poh MM. Plastic and Reconstructive Surgery, 2019;143(5):1081e–1091e.
• Facial Gender Confirmation Surgery: Facial Feminization Surgery and Facial Masculinization Surgery. Deschamps-Braly JC. Clinics in Plastic Surgery, 2018;45(3):323–331.
• Technical and Clinical Considerations for Facial Feminization Surgery with Rhinoplasty and Related Procedures. Bellinga RJ, Capitán L, Simon D, Tenório T. JAMA Facial Plastic Surgery, 2017;19(3):175–181.