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.
Feminizing rhinoplasty (before)
Feminizing rhinoplasty (after)
Feminizing rhinoplasty (before)
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.
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.
Upper liplift with V to Y advancement of mucous membrane
Upper liplift