Rhinoplasty as part of gender-confirming surgery in male transsexuals: basic considerations and clinical experience.

Because psychotherapy will not change the profound incongruence between the objective biological sex and subjective gender identity experienced by transsexuals, hormonal and surgical treatment to change the body toward the experienced gender is the only way out of this dilemma. To allow the male-to-female transsexual to pass as a member of this gender in public, rhinoplasty may be as important as genital reassignment surgery. In this paper the surgical considerations on gender-confirming rhinoplasty are presented and discussed. From December 1985 to January 1996, 22 male-to-female transsexuals underwent rhinoplasty at the Department of Plastic and Reconstructive Surgery of the Academisch Ziekenhuis Vrije Universiteit to obtain a less masculine appearance. Although revisional surgery was performed in four patients, all were satisfied with the final result in that they were convinced that their faces had become more feminine. We conclude that in selected patients rhinoplasty may help to create a feminine countenance for male-to-female transsexuals.