Male Rhinoplasty

The angles a male plan is checked against

A male nose is generally expected to have less tip rotation. Standard analysis puts the nasolabial angle, measured from the columella to the upper lip, at roughly 90 to 95 degrees in men.

Over-rotating the tip is one of the clearest routes to a feminised result. The nasofrontal angle, where the nose meets the forehead, runs the other way: a deeper radix generally suits a male nose.

These are population averages. A published range describes a group, not the face in front of the surgeon, and a nose can measure correctly and still look wrong.

Why the dorsum stays straight, not scooped

The usual aim in male surgery is a straight dorsum, or one left very slightly high, rather than a concave one. A slight scoop that looks unremarkable on a woman's profile can read as distinctly feminised on a man's.

Reducing a dorsal hump is the commonest request in male rhinoplasty, and taking too much is the commonest error.

The dorsal aesthetic lines are the paired shadows running from the medial brow to the tip. They are conventionally hourglass shaped, narrowing through the middle third. In men they are generally kept stronger and less tapered.

Over-reduction costs more than the profile. Where a hump is lowered without adequately rebuilding the middle third, the upper lateral cartilages can descend and produce an inverted V deformity.

That is a common reason for revision surgery, and it often affects breathing as well as appearance.

Thicker skin, stronger cartilage and a longer wait

Men generally have a thicker nasal soft tissue envelope than women. Thicker skin conceals fine tip definition and commonly holds swelling for longer, so the settled result appears later than the twelve month figure usually quoted.

Refinement therefore comes from building structure the skin can drape over, rather than from removing cartilage, which tends to leave a soft and poorly supported tip. Where the concern is confined to the tip, see tip plasty.

Stronger cartilage cuts both ways. It holds a shape well once set, but it resists reshaping and springs back.

If an open approach is planned, beard growth is worth raising at the consultation. The columellar incision sits in skin that may be shaved.

Old injuries and the airway behind them

Many men seeking rhinoplasty have a history of nasal trauma, and the nose that looks crooked is often the nose that does not breathe.

Assessment should therefore cover the septum, turbinates and nasal valve internally, not appearance alone. Straightening a broken nose without addressing the septum behind it commonly disappoints on both counts.

Where both are involved the operation is usually septorhinoplasty. Where the concern is airflow alone, start with the breathing pages.

What a surgeon assesses, and what to check first

A surgeon will assess whether the nose can be changed in the way a patient is describing. That judgement is made at an in-person examination.

• Whether facial growth is complete. Surgical reference material describes the nasal skeleton as generally developed at approximately age 17 in males.
• Whether the change sought is a hump reduced, a crooked nose straightened or the tip refined while the profile stays masculine.
• Whether expectations of sharp tip definition exceed what a thick soft tissue envelope can display.
• Whether there is a history of nasal injury, and whether breathing is affected as well as appearance.
• General health and smoking, because both bear on healing.