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NOSE AND LIPS FEMINIZATION

Feminizing Rhinoplasty in MtF TS patients

It is important to understand the difference between a male nose versus a female nose when attempting a feminizing procedure. Additionally, the angle between the bottom of the nose and the upper lip is made more obtuse (95-110 degrees) and the tip is made more refined and angular. Consequently, we aim to reduce the overall framework in a male nose and produce a gentle slope or concavity over the bridge with subtle indenting curves along the side walls, rather than the straight walls seen in men. Additionally, the angle between the bottom of the nose and the upper lip is more obtuse (95-110 degrees) and the tip is more refined and angular. Imperfections are less tolerated in a female nose, and it should blend harmoniously with the other facial features.

Beverly Hills facial plastic surgeon Dr. Pincus

Feminizing rhinoplasty (before)


Beverly Hills facial plastic surgeon Dr. Pincus

Feminizing rhinoplasty (after)


Beverly Hills facial plastic surgeon Dr. Pincus

Feminizing rhinoplasty (before)


Beverly Hills facial plastic surgeon Dr. Pincus

Feminizing rhinoplasty (after)


Lip Feminization in MtF TS patients

Females generally have fuller, more pouty lips than males. This area of a woman's face can be quite alluring. It has been said that this inherent sexuality relates to a subconscious, psychological reference to the female genital area. In addition to being more prominent than in males, the female upper lip is slightly rotated upward, revealing the lower 2-4mm of the upper front teeth. On the other hand, men have a flatter vermilion without the pout seen in women.

Beverly Hills facial plastic surgeon Dr. Pincus

Fat augmentation to upper & lower lips


When feminizing the upper lip, we aim to reduce the white lip (the area between the bottom of the nose and the vermilion), in selected cases, via resection of skin and underlying muscle under the nose. It is accomplished by an excision that follows the curvature of the bottom of the nose, going into the nostrils to hide the scar. In some cases, removing more skin than muscle can actually produce increased "vermilion show" with a slight rotation. Another method of lip augmentation involves advancing the mucous membrane behind the "wet line" (where the upper & lower lips meet) around to the front. This is called a "V to Y advancement". Generally the upper lip requires three adjacent advancements and the lower lip only one centrally. The red lip, itself, can also be enhanced with fat injections, dermal grafts, or even implants. Injections of a naturally occurring substance called "hyaluronic acid" can also be performed. Though non-permanent, it lasts several months to a year and provides an immediate augmentation without having to undergo surgery. Finally, a less often used method for reducing the white lip and, at the same time, enhancing the red lip is the direct excision of tissue over the vermilion border. It is the only procedure that can change or create a desired shape to the upper lip. However, it does produce a scar which may or may not be very obvious and require the use of lipstick to conceal it.


Beverly Hills facial plastic surgeon Dr. Pincus

Upper liplift with V to Y advancement of mucous membrane


Beverly Hills facial plastic surgeon Dr. Pincus

Upper liplift

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Procedures

Rhinoplasty

Being centrally located, the nose should blend harmoniously with the other facial features and not draw attention to itself.
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Neck Lift

The necklift is a procedure to tighten and better define the jawline and the areas below it. In some instances, this effect can reach all the way down to the collar bones
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Face Lift

Surgeons use the term "facelift" to describe any procedure on the face that results in a tighter, more youthful appearance.
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Revision Rhinoplasty

The operation consists of correcting areas of asymmetry and deformity resulting from a prior surgery.
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Eyelid-Brow Lift

The eyes are the first features noted when people meet. And having puffy, sagging or wrinkled eyelids can convey a false image of being tired, sad or old.
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Lips

The lips should be full and wide with the upper lip slightly rotated, revealing the lower portion of the front teeth.
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Articles

The Telltale Signs of a Bad Rhinoplasty

Having revised thousands of rhinoplasties, I have noticed certain features common to all.

Even a structurally symmetric, aesthetically pleasing nose can be a poor result if it is out of proportion with the other facial features by being too small or too large. However, the real clues to a poor result are the asymmetries, malpositions, disproportions and decreased function that are seen. We can see collapse of the side walls and/or nostrils producing a “pinched look” or asymmetry between the two sides. The bridge can be too low or too high, and the tip can be overly rotated or not rotated enough. There can be too much “nostril show” from aggressive cartilage resection causing upward migration of the nostril rims. Or too much nostril show from failure to raise the columella (area between the nostrils). Also, irregularities or distortions in the nasal tip can occur which can present technical challenges to the revision surgeon. There can be deflections or angulations of the tip or the entire nose. As mentioned above, nostril asymmetries are particularly common with one nostril appearing higher or wider than its companion. Finally, there can be a worsening of breathing , especially if a reductive rhinoplasty was performed. Making a nose smaller has to be accompanied, many times, by measures to assure that the airflow is not compromised. This means correcting any septal deviations and/or turbinate enlargement, as well as maintaining adequate openings through the nostrils and the areas above called the internal valves. I’ve included photos of a nose showing most of these deformities with the subsequent post-operative results, after I corrected them.


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