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Male Rhinoplasty
The Clinical Problem ( Fig. 20.1 )
Rhinoplasty remains the most common aesthetic procedure in men, with 55,000 performed in 2014 alone. Male anatomic variation, frequent posttraumatic pathology, desired aesthetic differences, and the resultant technical nuances make a male rhinoplasty a different and unique challenge. Additionally, there is a negative connotation of the male rhinoplasty patient; it has been suggested they are difficult to satisfy and have the potential for psychological pathology ( Box 20.1 ). The reports of male rhinoplasty patients' violent encounters with their surgeons and other perceived male psychological issues have led to the development of screening recommendations from Gunter ( Box 20.2 ).
Box 20.1
SIMON Mnemonic
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S ingle
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I mmature
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M ale
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O verly expectant
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N arcissistic
Box 20.2
Screening Recommendations: 13 Danger Signs
- 1.
Minimal disfigurement
- 2.
Delusional distortion of body image
- 3.
Identity problem or sexual ambivalence
- 4.
Confused or vague motives
- 5.
Unrealistic expectations for changes in life situation as a result of surgical treatment
- 6.
Poorly established social or emotional relationships
- 7.
Unresolved grief or crisis situation
- 8.
Blaming of misfortune on physical appearance
- 9.
Excessive concern about aging
- 10.
Sudden anatomic dislike
- 11.
Hostile attitude toward authority
- 12.
History of physician dissatisfaction
- 13.
Paranoid thoughts
While caution should always be applied in patient selection, current literature and the authors' experience do not support the higher prevalence of body dysmorphic disorder, decreased satisfaction, or more violent encounters with men.
Surgical Preparation and Technique
Preoperative Evaluation
An initial intake questionnaire allows a relaxed way to inquire about medical, psychiatric, and social history. The surgeon's initial discussion with the patient should raise these simple questions:
- 1.
What bothers you about your nose (aesthetic and/or functional concerns)?
- 2.
What do you like about your nose?
- 3.
What would you like your nose to look like?
- 4.
What are the desired male nasal aesthetics ( Box 20.3 )?
Box 20.3Male Nasal Aesthetics-
Straight, strong dorsum
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Strong dorsal aesthetic lines
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Less tip rotation: 90–95 degrees
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Nasofrontal angle: 138 degrees
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Nasofacial angle: 38 degrees
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Thick skin, wider tip
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Nasal bones wider: 80% of intercanthal distance to 2 mm < intercanthal distance
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Smaller columella-lobular angle: 10–30 degrees for men vs. 45 degrees for women
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