Bellinga Raúl J, Capitán Luis, Simon Daniel, Tenório Thiago
FACIALTEAM Surgical Group, Marbella High Care International Hospital, Marbella, Málaga, Spain.
JAMA Facial Plast Surg. 2017 May 1;19(3):175-181. doi: 10.1001/jamafacial.2016.1572.
Together with the forehead reconstruction, feminization of the nose is one of the most common procedures in facial feminization surgery. Rhinoplasty surgical techniques, which provide correct support and stability in the midterm to long term, are essential for obtaining a predictable result.
To report on the technical and clinical considerations of rhinoplasty and related procedures to feminize the nose, harmonize the nose in relation to the other modified structures (mainly the forehead and maxillomandibular complex), and achieve an aesthetic result beyond gender differences.
DESIGN, SETTING, AND PARTICIPANTS: Case series study of feminization rhinoplasties, in combination with lip-lift techniques, forehead reconstruction, and other procedures, were performed at a private practice between January 11, 2010, and May 29, 2015, in 200 consecutive male-to-female transgender patients. The mean (SD) medical follow-up for patients was 32 (18.84) months (range, 12-77 months). Frontonasal angles were objectively measured. Postoperative and long-term patient satisfaction were assessed.
Clinical analysis and evaluation using the 5-point Nose Feminization Scale, with 1 indicating very masculine or nose is worse and 5 indicating very feminine or exceptional result.
In these 200 patients, the mean (SD) age was 40.2 (12.2) years (range, 18-70 years). The mean (SE) frontonasal angle changed from 133.64° (0.63°) to 149.08° (0.57°) (difference in means, -15.44; 95% CI, -17.12 to -13.76; P < .001). Most patients considered their nose to appear more feminine after the surgery, and the degree of satisfaction after the rhinoplasty was 4 (much better) of 5 points on the Nose Feminization Scale. During the evaluation of feminization rhinoplasties, special attention was given to how the nose relates to other features essential to the identification of facial gender: the forehead and maxillomandibular complex. Emphasis was placed on the midterm to long-term stability of the results by reinforcing the internal structure.
In this case series of feminization rhinoplasties in combination with lip-lift techniques and forehead reconstruction, frontonasal angles were changed, and patient satisfaction with outcomes was high. The main goal of rhinoplasty in facial feminization surgery is to obtain feminine nasal features and the harmonization of the nose with the rest of the face. Lip-lifts and frontonasal recontouring can complement rhinoplasties associated with facial feminization surgery.
与额头重建一起，鼻部女性化是面部女性化手术中最常见的手术之一。鼻整形手术技术能在中长期提供正确的支撑和稳定性，对于获得可预测的效果至关重要。
报告鼻整形及相关手术的技术和临床考量，以使鼻子女性化，使鼻子与其他改变的结构（主要是额头和上颌下颌复合体）相协调，并实现超越性别差异的美学效果。
设计、地点和参与者：对2010年1月11日至2015年5月29日期间在一家私人诊所对200例连续的男变女跨性别患者进行的女性化鼻整形术结合提唇技术、额头重建及其他手术的病例系列研究。患者的平均（标准差）医学随访时间为32（18.84）个月（范围12 - 77个月）。客观测量额鼻角。评估术后和长期患者满意度。
使用5分制鼻女性化量表进行临床分析和评估，1分表示非常男性化或鼻子更差，5分表示非常女性化或效果极佳。
在这200例患者中，平均（标准差）年龄为40.2（12.2）岁（范围18 - 70岁）。平均（标准误）额鼻角从133.64°（0.63°）变为149.08°（0.57°）（均值差异为 - 15.44；95%置信区间为 - 17.12至 - 13.76；P < 0.001）。大多数患者认为术后鼻子看起来更女性化，鼻整形术后的满意度在鼻女性化量表上为5分中的4分（好多了）。在评估女性化鼻整形术时，特别关注鼻子与对面部性别识别至关重要的其他特征的关系：额头和上颌下颌复合体。通过加强内部结构强调了结果的中长期稳定性。
在这个结合提唇技术和额头重建的女性化鼻整形术病例系列中，额鼻角发生了变化，患者对结果的满意度很高。面部女性化手术中鼻整形的主要目标是获得女性化的鼻部特征并使鼻子与面部其他部位相协调。提唇术和额鼻重塑可以补充与面部女性化手术相关的鼻整形术。
4级。
