Rhinoplasty is perhaps the most challenging and elegant procedure within all of plastic surgery. In this issue of JAMA Facial Plastic Surgery, Bellinga et al1 provide a general review of their approach to feminization rhinoplasty as it relates to facial feminization for transgender women. I find, however, that feminization rhinoplasty techniques are applicable to all women. In fact, I strongly believe that considering gender cues when performing rhinoplasty can provide a better result than going by typically published “standard” aesthetic measurements.
There have been thousands of scholarly articles devoted to nasal analysis and nuances of technique. Mathematical evaluations of nasal shape have dominated the thoughts of rhinoplasty surgeons for decades with consideration given to ratios and angles as indicators of beauty, with some of the commonly considered guidelines being hundreds of years old.
Although these measurements may possibly provide some insight into the “what” of beauty, they provide no insight into the “why.” In other words, why do we consider certain shapes to be attractive? Although some suggest an inherent “golden ratio” that indicates beauty in shapes throughout nature, careful application of phi ratio to facial features has failed to produce the desired comeliness, and in fact, has generally resulted in a harsher, more masculine face.