Efficacy and Morphometric Outcomes of Combined Rhinoplasty-Lip Lift for Facial Feminization Surgery

Midface feminization in facial feminization surgery (FFS) addresses nasal and perioral features. Rhinoplasty and upper lip lift are commonly used procedures that can be combined into a single surgery. This study quantitatively describes baseline morphometric characteristics and changes in FFS patients who underwent either combined rhinoplasty-lip lift or isolated rhinoplasty, assessing the efficacy of the combined approach for patients with excessive philtral height. Retrospective analysis of preoperative and postoperative 3-dimensional images of 40 FFS patients, 20 who underwent combined rhinoplasty-lip lift and 20 who underwent isolated rhinoplasty, was performed to assess changes in 11 morphometric parameters. Baseline morphometric characteristics and preoperative to postoperative changes were compared between cohorts. Nasolabial angle increased postoperatively in both cohorts but only reached significance in the combined cohort (+6.6±11.6 degrees, P=0.02 versus +1.7±7.7 degrees, P=0.32). Philtrum length decreased significantly only in the combined cohort (-4.7±1.7 mm, P<0.001 versus +0.5±1.7 mm, P=0.21), and nasofrontal angle increased significantly in both cohorts (+5.5±3.5 degrees, P<0.001 versus +3.0±5.0 degrees, P=0.02). Morphometric changes were otherwise comparable. Three patients who underwent the combined procedure received postoperative triamcinolone injection for scar reduction; these patients trended toward a greater nasolabial angle both preoperatively (124.5±10.1 degrees versus 110.5±13.9 degrees, P=0.12) and postoperatively (131.4±17.8 degrees versus 117.1±10.7 degrees, P=0.08). Complication rates were low in both cohorts. Overall, combined rhinoplasty-lip lift is safe, achieves philtral shortening, and may enhance nasolabial angle increase in selected patients undergoing midface feminization.