LAUSR

Ethnic Considerations for Rhinoplasty in Facial Feminization To the Editor The recent publication by Bellinga and colleagues1 highlights a case series of feminization rhinoplasties to identify important factors to achieve superior long-term results and to improve patient satisfaction. This work contributes to a small but growing collection of research in facial feminization, which has become an area of interest in facial plastic surgery. The authors highlight the importance of sufficient long-term support and stability through manipulation of the osteocartilaginous skeleton of the nose and cartilage grafting as well as lip-lift and nasofrontal transition modification for improved aesthetic outcomes. The authors identify 3 objectives in planning a rhinoplasty in the context of facial feminization surgery, including feminization of the nose, creating harmony between the feminized nose and other modified facial structures, and achieving aesthetic results that transcend gender differences. In the Invited Commentary for that article, Spiegel2 notes that in facial feminization, it is important to create an unambiguously feminine form of the nose because the transgender womanmustovercomeaconstellationofphysicaltraitsthatsend male gender cues. The female nose is described as having a straight narrow bridge, well-defined projecting tip, refined alae, and a nasolabial angle of approximately 95° to 100°.3 However, as with most aesthetic ideals, these characteristics are the ideal for white women and may not result in a successful and racially congruent aesthetic result in all patients. Many studies have been published describing differences in the nasal aesthetics of different ethnicities; in their comprehensive review, Rohrich and Bolden3 described the multiple anatomic variants of nasal aesthetics even within each ethnic group, which highlights the importance of ethnic rhinoplasty techniques. Facial feminization surgery can significantly enhance the quality of life and reduce the psychosocial sequelae faced by transgender women, who are often marginalized and discriminated against in health care and society.4,5 When planning for rhinoplasty in facial feminization, it is imperative that the surgeon does not rely solely on the aesthetic standards used for white rhinoplasty patients or classic rhinoplasty techniques in transgender women of other ethnicities. The surgeon should determine each individual patient’s aesthetic goals during the preoperative consultation and develop a surgical plan that is informed by the patient’s anatomy, ethnicity, and desires to achieve a result that is feminine, aesthetically pleasing, and harmonious in the context of the entire feminized face.