Background <p>Cosmetic rhinoplasty may influence psychosocial well-being; however, evidence regarding postoperative sexual function remains mixed. This study evaluated changes in female sexual function, depressive symptoms, and self-esteem before and 6 months after primary cosmetic rhinoplasty in sexually active married women.</p> Methods <p>This prospective cohort enrolled married women (22–48 years) undergoing primary cosmetic rhinoplasty by a single surgeon. Participants completed the Female Sexual Function Index (FSFI), Patient Health Questionnaire-9 (PHQ-9), and Rosenberg Self-Esteem Scale (RSES) preoperatively (T0) and at 6 months (T1). Categorical shifts between T0 and T1 were analyzed using the McNemar test (two-sided <i>p</i>&lt;0.05).</p> Results <p>Of 70 enrolled women, 64 completed follow-up (mean age 35 ± 6 years). Sexual function improved, with FSFI increasing from 24.20 ± 7.75 to 27.22 ± 6.84 (<i>p</i>=0.021) and a shift toward higher FSFI categories (high function: 21.9–37.5%, <i>p</i>&lt;0.001). Depressive symptoms decreased, with PHQ-9 falling from 8.81 ± 6.34 to 4.97 ± 3.96 (<i>p</i>&lt;0.001) and an increased proportion classified as nondepressive (31.3–56.3%, <i>p</i>&lt;0.001). Mean RSES increased from 22.86 ± 6.79 to 24.61 ± 5.57 (<i>p</i>=0.113), while the proportion with high self-esteem rose from 53.1 to 65.6% (<i>p</i>&lt;0.001).</p> Conclusions <p>Primary cosmetic rhinoplasty was associated with improved depressive symptom burden and favorable shifts in sexual function categories at 6 months, with mixed findings for self-esteem. Psychosocial outcomes should be interpreted within a biopsychosocial framework, supporting structured preoperative psychological assessment and referral when indicated.</p> Level of Evidence III <p>This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.</p>