FTM Rhinoplasty for Facial Masculinization Surgery

Medically reviewed by Jennifer Richman on July 8, 2025.

Understanding FTM Rhinoplasty and Its Significance in Gender Affirmation

Rhinoplasty is a common part of facial masculinization surgery (FMS). Since testosterone hormone therapy doesn’t alter the structure of the nasal bone or cartilage, patients with gender dysphoria related to their nose shape often choose this type of gender-affirming surgery. FTM rhinoplasty, or masculinizing rhinoplasty, may involve adjusting the bridge, refining the nasal tip, or altering overall proportions to create a more masculine profile.

Every face is different, and our surgeons will help reshape your nose in a way that complements your features without compromising your individuality. The goal is not to erase who you are, but to affirm your gender, honoring your unique identity.

Differences Between Male and Female Nasal Structures

The influence of hormones during puberty can shape nasal features in distinct ways. Testosterone-dominant puberty typically results in a nose that is broader and more prominent, with a wider bridge and a downward-angled tip, often creating a right angle between the base of the nose and the upper lip.

In contrast, estrogen-dominant puberty often results in a smaller, slimmer, more curved nose with more curved and an upwardly turned tip. These structural differences are common and reflect the role of puberty in facial development.

Cultural Perceptions of Masculinity in Nose Aesthetics

Cultural perceptions often shape how we view the aesthetics of the nose. Nasal features also carry deep ties to family and ethnic identity—details that many patients want to honor as they pursue facial masculinization. Instead of aiming for a one-size-fits-all result, our surgeons will work closely with you to balance personal and cultural elements with gender-affirming goals. For example, some patients may want to preserve bumps in their nose bridge or wide nostrils through surgery.
The GCC provides surgical consultations where patients frequently bring family photos to help communicate their goals, using familiar features as a guide for what best represents their identity.

Nasal Features Commonly Considered in Gender-Affirming Surgery

• Dorsal bump (nasal bridge bumps)
• Width of the nose bridge
• Width and angle of the nasal tip

Is Facial Masculinization Surgery Right for Me?

Candidacy requirements

Transgender rhinoplasty is offered to adults who are mentally fit to undergo surgery and can provide informed consent, meaning they understand the risks, benefits, and expected outcomes and have realistic goals. Good candidates are in overall good health and are evaluated during a free consultation. Hormone replacement therapy (HRT) is not required for this procedure. However, for patients already on HRT, a full-dose regimen of 12 to 18 months is recommended before pursuing gender-affirming facial surgery to allow for soft tissue and fat redistribution to stabilize. This waiting period is less relevant for rhinoplasty, as hormones don’t affect adult nasal cartilage or bone.

Eligibility and Recommendations

• Open to adults who are mentally fit and able to give informed consent, understanding the procedure, its risks, and realistic outcomes.
• Ideal candidates are in good health and discuss expectations during a free consultation.
• HRT is not required for transgender rhinoplasty.
• For those on HRT, 12–18 months of treatment is recommended before facial surgery to allow soft tissue changes to settle.
• Hormones don’t affect nasal cartilage or bone, so waiting is less critical for rhinoplasty.

Motives for undergoing surgery

Testosterone therapy can help align external appearance with gender identity, but it has limitations. In adults, it does not alter the structure of bone or cartilage. This means HRT alone might not resolve face-related gender dysphoria for some individuals. When dysphoria is heavily tied to facial features that remain unchanged by hormones, surgery could be worth considering.

Before deciding on next steps, it’s helpful to ask yourself: Has my discomfort with my facial appearance been consistent over time, and would surgery significantly reduce that discomfort? For many, reshaping the nose can boost feelings of affirmation or gender euphoria. Request a free consultation today to create a personalized surgical plan.

What Is FTM Rhinoplasty?

Facial masculinization rhinoplasty, often part of facial masculinization surgery (FMS), is designed to create a nose with features commonly influenced by testosterone, such as increased overall size, a wider bridge, and stronger projection. To achieve this, surgeons may widen the nasal bridge, smooth dorsal humps, and adjust the tip to project more and angle slightly downward.

These changes are often supported with cartilage or bone grafts taken from other parts of the body, most commonly the ribs. Synthetic implants, such as silicone or ePTFE, may also be used to reinforce the structure and further shape the nasal framework.

The FTM Rhinoplasty Procedure: What to Expect

Before FTM rhinoplasty, you’ll meet with your surgeon to discuss your goals, review your medical history, and undergo a physical exam to assess your nasal structure and overall health. The procedure is typically done under general anesthesia. You will be instructed to stop smoking and avoid aspirin, anti-inflammatory drugs, and certain supplements to reduce the risk of bleeding. Photographs of your nose will be taken to help guide the surgical plan. Arranging for someone to drive you home and stay with you after the procedure is recommended, as most patients can return home the same day following surgery.

There are two primary surgical approaches:

• Open rhinoplasty involves an incision at the base of the nose. This method allows the surgeon to fully access the nasal structure and make more significant changes.
• Closed rhinoplasty utilizes a small incision inside the nostril, enabling more subtle adjustments without externally visible scarring.

Frequently Asked Questions

What is recovery like after a gender-affirming rhinoplasty?

After surgery, it’s common to have a cast over the bridge of the nose and internal splints supporting the septum. A gauze dressing is usually placed between the nose and upper lip to catch blood or drainage and may need to be changed several times a day. This gauze is typically removed within one to two days, as instructed by your surgeon. Avoid blowing your nose for two weeks, and don’t rest anything on the nasal bridge—like glasses—for at least three months. Swelling can take up to a year to fully resolve, with final results gradually becoming more visible over time

Will a rhinoplasty or nose job leave scarring?

No. Open rhinoplasty leaves a small incision at the base of the nose. This usually fades with time and often becomes barely noticeable. Closed rhinoplasty involves incisions made inside the nostrils, which will heal to leave no visible external scarring.

Will testosterone hormone therapy cause my nose cartilage to grow?

As an adult taking gender-affirming hormone replacement therapy, you will not see changes to the bone and cartilage of your face. Facial bones and cartilage typically finish developing by the late teens or early twenties. Starting testosterone therapy after this point won’t change the structure of the face, since those features have already matured.

How much does facial masculinization surgery cost? Can I get it covered by insurance?

The procedure can cost more than $6,000 out-of-pocket. Insurance may cover some or all of the cost if your plan includes gender-affirming care. To qualify, you typically need a support letter from a licensed provider and at least 12 continuous months of testosterone therapy unless there’s a medical reason you can’t undergo HRT. Coverage and requirements may vary, so it’s important to check directly with your insurance provider.

Potential Risks and Complications

Before surgery, it’s essential to know the risks and plan ahead to support a smooth recovery:

• All procedures carry risks like infection, bleeding, fluid buildup (seromas), and reactions to anesthesia.
• Share your complete medical history—including medications, supplements, and allergies—to help your care team reduce those risks.
• Facial surgeries are more complex due to the delicate, visible areas that can affect healing, sensation, or symmetry. Issues like asymmetrical results are rare when you undergo surgery with experienced, board-certified craniofacial surgeons.
• Choosing a board-certified surgeon with experience in facial masculinization surgery lowers the chance of complications.
• Quitting tobacco and nicotine before surgery helps improve healing and reduces the risk of nerve damage or delayed recovery.