Purpose: To investigate whether gender preferences of nasion position could be detected which could serve as guides to nasion alteration during rhinoplasty.

Methods: North American Caucasian males (n=75) and females (n=75) were surveyed to identify their preference of various nasion positions in both the sketched male and female profile faces. The nasion position with regards to its height (horizontal position) and level (vertical position) were altered while all other facial and nasal anthropometric measurements were held constant. The nasion height parameters were set at 7, 10, and 13 mm anterior to the corneal plain and the nasion levels were set at the supratarsal fold (ST), upper lid ciliary margin (CM), midpupil (MP), and lower limbus (LL). Patients were asked to rank the facial profiles in order of aesthetic preference.

Results: The rank orders for both the male and female nasion position preferences were tabulated from completed surveys as shown in the tables below.

Female Nasion Position	7 mm anterior to corneal plain		10 mm anterior to corneal plain		13 mm anterior to corneal plain
	Female rank	Male rank	Female rank	Male rank	Female rank	Male rank
ST	11th	9th	3rd	3rd	8th	6th
CM	9th	10th	1st	1st	7th	5th
MP	10th	11th	2nd	2nd	4th	4th
LL	12th	12th	6th	8th	5th	7th

Male Nasion Position	7 mm anterior to corneal plain		10 mm anterior to corneal plain		13 mm anterior to corneal plain
	Male rank	Female rank	Male rank	Female rank	Male rank	Female rank
ST	9th	10th	1st	1st	4th	4th
CM	10th	9th	2nd	2nd	5th	5th
MP	11th	11th	3rd	3rd	6th	6th
LL	12th	12th	8th	8th	7th	7th

The selections made by the female and male subjects demonstrated statistical significance amongst the various ranks as a whole as demonstrated by One way ANOVA analysis (P< 0.001). Further analysis using a post Dunn’s test was completed to delineate significant preferences between subgroups with respect to the nasion level and height. Female nasion levels were preferred at CM and MP versus LL based on female ranks and at ST, CM, and MP versus LL based on male ranks (P<0.05). Additionally, female nasion heights were preferred at 13 mm and 10mm versus 7 mm anterior to the corneal plain based on female ranks and preferred at 10 mm versus 13mm and 7 mm anterior to the corneal plane based on male ranks (P< 0.05). Male nasion levels were preferred at ST, CM, and MP versus LL based on both male and female ranks (P< 0.05). Male nasion heights were preferred at 10mm versus 13 and 7 mm anterior to the corneal plain by both male and female ranks (P< 0.05).

Conclusion: Females and males tended to agree on their preference of the male nasion position being tolerant to ST as well as CM and MP levels and preferring a height of 10 mm anterior to the corneal plain. Female subjects were less tolerant of the female nasion height being set at ST and instead preferred a CM or MP position but were more tolerant with regards to nasion height accepting a 10 or 13 mm distance from the anterior corneal plain. Over all, both genders were less tolerant to a nasion height of 7 mm and a nasion level set at the LL, providing credibility to recent trends favoring nasal dorsum and nasion augmentation during rhinoplasty.