Although the attractive female nose has varied in appreciation over the years, depending on the changing role of women in society, the handsome male nose is unchanged since the days of the Renaissance. In male nasal aesthetics, a masculine nose is characterized on profile by a strong nasal dorsum in which there is rarely a supratip break (Fig. 3). The desired dorsal line is either straight or has a small bony hump at the rhinion (Fig. 4). Dorsal height is recognized by most male patients as desirable, as witnessed by the fact that male patients with even mild congenital or iatrogenic (postrhinoplasty) saddling request dorsal augmentation (Fig. 5). In our patient population, a significant number of the Hispanic and Central and South American patients specifically request that a little convexity be left.

	Fig. 3. A, This 41 -year-old man disliked the fullness of his nasal dorsum and wanted further refinement of his nasal tip. B, The postoperative result shows an ideal male nasal dorsum with good strength and no supratip break. Analysis of the columella postoperatively shows improvement of a retrusive columella that was accomplished with the use of a columellar strut placed low between the medial crura. The tip was refined using a double-dome technique with cephalic trimming of the lower lateral cartilages.

	Fig. 4. A and C, Two male patients with decidedly large dorsal humps. A, A 37-year-old who presented with the desire to change his dorsum. B, A large dorsal hump was removed with a straight dorsal result. C, A 41-year-old man with a history of nasal injury who wished to retain some of his dorsal fullness. D, His postoperative result shows a reduction of the dorsal hump with some desired fullness remaining. Individuals who seek cosmetic rhinoplasty often want more changes than do those who have sustained nasal injury as evidenced by these two patients. Additionally, as patients get older they psychologically tolerate less of a change in the shape of their nose since they have lived with it for so long.

	Figure 5. This patient developed dorsal saddling secondary to a previous rhinoplasty surgery. He presented desirous of augmentation to the dorsum. This patient reflects probably the number one mistake that is made in male rhinoplasties—that of feminizing a male nose.

The nasal tip rotation should never give a turned-up appearance to the nose, and a nasolabial angle of no more than 90 or at most 95 degrees is preferable (Fig. 6).20 On the other hand, an acute nasolabial angle that creates a droopy nasal tip gives one the appearance of an unattractive aging nose that can prematurely age a young patient (Fig. 7).

	Fig. 6. A and B, Although male patients often want the dorsum taken down to a straight bridge profile, rarely do they wish to have the nose rotated past a 90- or 95-degree angle. B, The postoperative result effectively illustrating the preferred 90- to 95-degree nasolabial angle desired postoperatively.

	Fig. 7. A, This 30-year-old man appears older than his stated age in his preoperative view. He had tip ptosis that prematurely aged him. B, The postoperative results of revision rhinoplasty surgery with a lateral crura overlay technique as well as a columellar strut and double- dome suturing.

Most men wish for a strong, balanced facial profile that gives the impression of personal confidence. Those who recognize that a weak or retrusive chin gives a diminutive or follower-rather-than-leader look often grow a beard or goatee on their own to hide this deficiency and often request chin augmentation simultaneously with the rhinoplasty (Fig. 8). Those without this sense of what it is that gives them a poor profile often concentrate on the nose as the offending feature, especially because it looks larger because of the retrusive chin. Chin augmentation actually allows the surgeon to reduce the dorsum less, which is particularly helpful in those with thick skin that might not retract with a greater cartilage or bony removal. Psychologically, the less the dorsal reduction, the more masculinity is preserved. Occasionally, flat cheekbones too can make the nose look larger, and malar or submalar implants can add further balance (Fig. 9).

	Fig. 8. A and B, This 34-year-old man had previous nasal trauma and had difficulty breathing at the time of his surgery. He desired to have his nasal dorsum reduced but wished to maintain a strong profile. He also did not want a down turn of the nostrils. Nasal surgery alone would not have given him the profile balance necessary to give an assertive look, and therefore chin augmentation was also necessary. Nasal surgery required dorsal reduction, a 3-mm resection of the caudal septum, a double-dome tip technique, and a 3-mm resection of the cephalic margin of lower lateral cartilages.

	Fig 9. A, This 35-year-old man disliked his nasal prominence. His profile was weakened by both a retrusive chin and a sunkenin appearance of the soft tissue of the cheeks. In addition to rhinoplasty, he underwent chin augmentation and submalar cheek augmentation. B, The result shows a more balanced, confident, and younger profile secondary to the filling out of the hollow cheek deformity.

From the front view, which is indeed the view that most patients see every day in the mirror, the dorsum should be straight and, in the man, unlike the woman, there may be a little fullness laterally to the nasal bones at the rhinion and just above that helps to give the man a slightly more rough or chiseled look. At the base, one should not be able to see more than just a hint of the nostril opening. The tip itself can be broad, but a bulbous or boxy tip, in which the lower lateral and dome cartilages predominate and separate the tip from the rest of the nose, is unwanted (Fig. 10).

	Fig. 10. A, C, and E, The preoperative appearance of this 56-year-old man who presented with an extremely bulbous, large bifid nasal tip that was ptotic and had marked columellar show. The dorsal profile showed a hump. B, D, and F, The postoperative result that required significant trimming of the cephalic margin of the lower lateral cartilages, a dome truncation technique, and a double-dome technique. The columellar show was handled with a tongue-in-groove maneuver. This patient developed a postoperative infection and chondritis, causing some dorsal saddling that was later repaired with a conchal cartilage graft. The postoperative photos here are after the secondary surgery but still show a deslrable appearance even after a severe infection and chondritis. Illustration continued on following page

	Fig. 10 (Continued).