RHINOPLASTY AS PART OF GENDER-CONFIRMING SURGERY IN MALE-TRANSSEXUALS- BASIC CONSIDERATIONS AND CLINICAL-EXPERIENCE

Because psychotherapy will not change the profound incongruence betwee n the objective biological sex and subjective gender identity experien ced by transsexuals, hormonal and surgical treatment to change the bod y toward the experienced gender is the only way out of this dilemma. T o allow the male-to-female transsexual to pass as a member of this gen der in public, rhinoplasty may be as important as genital reassignment surgery. In this paper the surgical considerations on gender-confirmi ng rhinoplasty are presented and discussed, From December 1985 to Janu ary 1996, 22 male-to-female transsexuals underwent rhinoplasty at the Department of Plastic and Reconstructive Surgery of the Academisch Zie kenhuis Vrije Universiteit to obtain a less masculine appearance. Alth ough revisional surgery was performed in four patients, all were satis fied with the final result in that they were convinced that their face s had become more feminine, We conclude that in selected patients rhin oplasty may help to create a feminine countenance for male-to-female t ranssexuals.