Male rhinoplasty can be performed at the age of 15 years or older and the candidates are people who are currently unhappy with their nose appearances and would like to improve the shape of it, as well as those who seek health-related improvements such as correcting a deviated nasal septum that causes difficulty breathing.
Patients should be in a good health, both physically and mentally and their expectations should be realistic. The main difference between the male rhinoplasty and the female rhinoplasty is that men tend to have thicker skin layers and a stronger bone and cartilage structures. Male rhinoplasty surgeries are usually done in a technique which retains their masculine looks - characterized by a strong and straightened nasal dorsum. They usually do not look for a small, soft looking nose as women often do.
For male patients, the endonasal 3D rapid recovery technique without an external scar on columella is used more commonly than the external (open) rhinoplasty approach. Dr. Sam Rizk does both the endonasal (closed) and open (external) rhinoplasty techniques and chooses the best approach for your specific nose. The best angle between the nose and upper lip for men is usually around 90 degrees which is different from the ideal angle in women. The space between the upper lip and nose is also a factor Dr. Rizk considers when he rotates the nose to an ideal angle. Because men have thicker skin, sometimes a combined laser procedure to shrink the pores and skin may be performed with the rhinoplasty or at a later time. The best laser for this is the fractionated co2 laser which leaves the skin smoother with a rapid recovery and no discoloration. Men tend to also have more injuries from sports and tend to have deviated noses and difficulty breathing from a deviated septum. These functional issues will be addressed by Dr. Rizk at the same time so the patient's nose is not just cosmetically improved but also functions better with better breathing.
A male rhinoplasty procedure that improves and/or maintains the natural masculine look has to be done carefully in a conservative approach and the overall look have to be coordinated with the rest of the face to achieve facial harmony.
Sometimes, explains Dr. Sam Rizk, a New York facial plastic surgeon, he will recommend the patient to combine the nose surgery with other cosmetic surgery procedures, mainly a facelift and/or chin implants if he sees that the nose is too pointy compared with the rest of the face, in order to shape a well-balanced face that would look great from different angles.
Male rhinoplasty is a distinct entity, not so much because of special techniques, but more because of psychological motivations of the male patient. The nose has a special meaning in most males, and operations that feminize the male nose make for unhappy patients. Proper screening is key, as the physician bears the responsibility for the outcome. Physiologically, most male noses have thick nasal tip skin that worsens with age, creating a bulbous, droopy tip that requires supporting and defining grafts. Additionally, because of the previous sports involvement, many males present with crooked noses, which are difficult to correct completely.
When approaching rhinoplasty in men, the surgeon must quickly differentiate between the patient whose motivation is for reconstructive surgery and the patient with no traumatic deformity or significant breathing problem whose concern is only cosmetic. Nasal injuries secondary to sports, altercations, or other mechanisms frequently involve men, and it is reasonable for these patients to wish to have the nose returned to a preinjury state without other modification. Some men truly present for evaluation for nasal obstruction who has a history of previous trauma and who also notices that his nose is crooked or irregular since his injury. This patient is much different from the male patient who has been bothered by the natural inherited shape of his nose. In either case, a medical clearance and occasionally a psychological evaluation is necessary before performing the surgery. Male patients in midlife (third to sixth decades) usually have a well-imprinted body image and should not have major changes in their noses. These patients respond best to conservative and subtle changes that maintain a natural look that does not draw undue attention to the nose. This is different from a male teenager who has a clearly oversized nose who wants to improve it cosmetically, who may undergo an operation which is conservative but may make dramatic changes in size of nose.
Computer Imaging and Patient Desires
A large number of male patients are indeed reasonable and do well postoperatively. Computer imaging further helps to serve as a screening and communication device, especially from the profile view. It enables the surgeon and the patient to come to a common goal or to disagree. Dr. Rizk will only operate on patients he agrees with on their aesthetic outcome. If a patient requests a feminized nose or spends a prolonged time in studying the image or asking for minute changes, there may be problems that require further evaluation.
Male Nasal Aesthetics
Although the attractive female nose has varied in appreciation over the years, depending on the changing role of women in society, the handsome male nose is unchanged since the days of Renaissance. In male aesthetics, a masculine nose is characterized in profile by a strong nasal dorsum in which there is rarely a supratip break. The desired dorsal line is either straight or has a small bony hump (slightly convex). Dorsal height is recognized by most male patients as desirable. The nasal tip rotation should never give a turned-up appearance to the nose, and a nasolabial angle of no more than 90 degrees or at most 95 degrees is preferable. On the other hand, an acute nasolabial angle that creates a drooping nasal tip gives one the appearance of an unattractive aging nose that can prematurely age a young patient. Most men wish for a strong, balanced facial profile that gives the impression of personal confidence. Sometimes, to achieve that balance it is necessary to perform a chin implant with the rhinoplasty. A weak or retrusive chin gives a diminutive or follower-rather-than-leader look to a patient.
Dr. Rizk has noticed that patients often grow a beard or goatee on their own to hide their chin deficiency and often request a chin implant simultaneously with the rhinoplasty. Sometimes the nose looks larger because of this retrusive chin and in these cases chin augmentation actually allows the surgeon to reduce the dorsum less, which is particularly helpful for a natural outcome. Psychologically, the less the dorsal reduction, the more masculinity is preserved. Occasionally, flat cheek bones too can make the nose look larger, and malar or submalar implants can add further balance. From the front view, which is the most important view, the dorsum should be straight and in men, unlike women, there may be a little fullness laterally to the nasal bones at the rhinion (mid-part of nasal dorsum) which helps to give the man a slightly more rough or chiseled look. At the base, one should not be able to see more than just a hint of the nostril opening. The tip itself can be broad, but not boxy or bulbous. A softly defined tip is still a masculine characteristic.
The Ethnic Male Nose
Patients with noses that characterize an individual as the member of a particular race, region, or ethnic group may wish to change that look so as not to be stereotyped and not have their own individuality potentially diminished or dismissed. For men, this may be particularly true in the business world, where fitting in is so important. It is not that these individuals resent their heritage; they just do not want to be labeled. An ethnic nose can indeed stand out, making its owner feel the "odd man out" when in the company of others not so endowed. Teenage boys are offered the most conscious of these ethnic identities and, because of their normal self-doubting, may rush to the plastic surgeon. It is up to the ethical physician to carefully screen out those with minimal deformities than from those with a really obtrusive nose. Also, with these teenage boys, it is important that the boy voices his concerns and needs for a change, not just the parent. Dr. Rizk will only perform teenage rhinoplasty if the boy and the parents both desire it together.
The following are typical stereotypes of noses. The Jewish dorsum is fully convex from with a hanging columella and rounded tip. The tip of the Arab nose is long and droopy. The Mestizo nose is short, underprojected with a rounded tip and thick nasal skin. The Black nose has a wider alar base with thick skin and a low nasal dorsum. The Asian nose has a rounded tip; an especially low dorsum with a very low starting point and weak tip. All the above noses are addressed differently and surgical goals must be directed to make the nose fit the face, using aesthetic proportions and analysis first described by Leonardo da Vinci.
The Droopy Tip: whereas an over rotated nasal tip gives a feminizing look to the male nose, an under rotated or droopy nasal tip gives an aging or unattractive appearance. This may be either genetic or gravity-related. There is no question the tip droops as we age. If you look at pictures of your grandparents when they were young and compare their noses to where they are now, you will clearly see this droop. It always appears as if a dorsal bump has grown with time, but rather the tip supporting mechanisms have weakened and the tip drops, creating a more acute nasolabial angle and making the dorsum appear more prominent. Because men generally start with larger noses, and because, over time, male nasal tip skin thickens more than women, this droop is more evident in men. Because of heavy and large nasal tips in the man, routine nasal tip rotation and support with cartilage grafts that are more robust, may be necessary. Generally a combination of conservative cartilage excision and cartilage grafting is needed to achieve a tip lift procedure and also making the tip appear more refined and defined. Suturing techniques also compliment the grafting and excision methods. These sutures reshape the bulbous or wide cartilages and add strength to the nasal tip as well.
The Underprojected Tip: Some droopy tips also lack projection and if only rotated look too small. Prominent nasal projection is also a male characteristic that should be preserved and should be created in those who lack it. By increasing the length of medial crura (part of tip cartilages) tip projection is obtained. Tip projection is also obtained with specialized tip grafting techniques. A commonly used graft is called a columellar strut which may accomplish tip support as well as projection. But often another graft is required called a shield graft or cap graft to establish more projection and definition. Dr. Rizk sometimes also uses a technique called "lateral crural steal" (part of tip cartilages) to push them out more and create more tip projection.
The Thick-Skinned Tip and Rhinophyma: Thick nasal tip skin can be a problem in the man that worsens with age as the glandular component of the skin increases. The previous cartilage techniques discussed alter the structure but not the skin itself. For this thick skin, sculpting or debulking the fat and glandular tissue can be performed in 3d from inside the nose or from an external approach in certain areas to achieve further refinement and definition using Dr. Rizk's 3D high definition methods. This is done conservatively so as not to disrupt the blood supply to the tip skin. Cartilage grafts are still necessary to provide a sharper structure underneath the overlying thick-tissue envelope. External peels with acids or laser treatments for the skin are often utilized to further enhance the result and decrease pore size in these patients.
The Injured and Crooked Nose: Nasal trauma secondary to sports injuries or altercations is relatively common among men. Most patients have complaints of difficulty breathing through the nose, and some may also point out an aesthetic deformity, such as a crooked shape. In the majority of patients, the patient is primarily interested in an open nasal airway. When offered surgery to correct a deviated septum, some may also ask for correction of the external deformity, thus returning the nose to the preinjured state. A few patients may ask for additional refinements, such as reducing a dorsal bump or narrowing a wide tip. Usually, the closed approach (endonasal) is used for these patients. All patients need to be informed that a perfectly straight nose is very difficult to achieve because obstacles, such as severe deflection of the bony pyramid, a deviated and buckled septum, cartilage memory, overall facial asymmetry, and the healing process itself, may compromise this effort. In many cases, if questioned, the patient remembers a deviation of the nose was present prior to the most recent injury. The primary goals of surgery should be to restore the patient's nasal airway and to restore the nose to its preinjury appearance or better.
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16 year old male with history of nasal injury complains of difficulty breathing and a deviated nose to the left. Patient has a saddle nose deformity in the cartilage part of the nose. Patient is shown 1 year after septorhinoplasty. Patient required a spreader and camouflage graft on the right side to straighten his nose and correct the nasal saddle on profile.
19 year old male with history of previous nasal injury and previous rhinoplasty complains of a crooked nose and a nasal bump as well as difficulty breathing. Patient is shown 1 week after endonasal septorhinoplasty with spreader and camouflage cartilage grafts on the left side to correct collapse in the cartilaginous middle part of the nose. Patient is noted to have minimal bruising after cast removal.
47 year old male who was very unhappy with shape of his nose and chin. Patient was mainly concerned about the worsening collapse on the right side of his nose and wanted some subtle improvement in his chin. Patient also had a deviated nose and difficulty breathing secondary to a deviated nasal septum. Patient underwent septorhinoplasty and chin implant and is shown after the surgery where multiple smoothly sculpted grafts were used to even out his tip and rotate his nose slightly. Subtle bump removal was also performed. The cartilage grafts were harvested from his nasal septum.
Patient is 33 yo Latino male who wanted better balance between his nose and chin and underwent rhinoplasty to remove the nasal bump and chin implant, neck liposuction, and necklift to define and project his chin more. Dr. Rizk does a special muscle tuck under the chin with 3d telescopes to achieve a better result than with just liposuction. This neck procedure is done only from a small incision under the chin and does not involve incisions around the ears.
19yo male who was involved in a major head /facial trauma and injured his nose resulting in a severe deviated nasal septum and a cartilaginous saddle nose deformity. Patient underwent septoplasty and rhinoplasty (endonasal) to repair his nasal septum and to place a cartilage graft from his septum into the saddle nose deformity. Patient is shown post-operatively at 6 months after surgery.
25 yo male who is interested in rhinoplasty. Patient also had difficulty breathing. Patient had primary male rhinoplasty with bump removal and a tip lift. The tip was also defined from the front view as well. Cartilage grafts were used from the nasal septum to support the nasal tip.
16yo male patient with history of multiple sports-related nasal injuries with complaints of a crooked nose, drooping nose, and inability to breathe. Patient underwent septorhinoplasty with grafts to correct collapse on the right side to correct a collapsing upper lateral cartilage. Patient is shown 6 months following the rhinoplasty.
45 year old male with previous rhinoplasty who presents for revision or secondary rhinoplasty. Patient has inverted v deformity, pollybeak deformity, a drooping nasal tip and a deviated septum to the right side. Patient is shown 6 months after revision rhinoplasty with septal cartilage grafts to correct the tip and middle vault of the nose.
This male rhinoplasty patient wanted mainly a change in profile with a minor/subtle refinement in the front view. Patient underwent rhinoplasty to elevate the nasal tip, remove the dorsal bump and do some minor tip refinement. Patient's tip was supported with a cartilage graft harvested from his septum. Patient is shown 3 months after surgery and has some swelling on front view which will take 1 year to completely resolve but a notable improvement in his profile can be seen.
45 year old male with history of prior nasal surgery who complains of a crooked nose with hanging columella and retracted nostrils. Patient also has difficulty breathing. Patient underwent septorhinoplasty with multiple spreader and batton cartilage grafts from his septum as well as correction of his caudal septum which was twisting his nasal tip. Patient is shown 1 year after revision septorhinoplasty.