Hello,I have a dorsal hump on my nose, and when smiling a slightly bulbous, droopy and boxy tip. My surgeon, an ENT, is going to perform endonasal/closed rhinoplasty. For my tip he has suggested minimal changes with sutures and scoring. I have thin skin, so any resections of cartilage or grafts will show through. I wanted a more refined tip, but I am thinking that scoring of the cartilage will make for a bigger bulkier appearance of the tip. If I am wrong please explain how scoring works Thanks!
Could You Explain How the "Scoring" Technique Works in Rhinoplasty? (photo)
Doctor Answers (7)
Scoring tehchinque in rhinoplasty
Rhinoplasty is a complex and precise procedure, various techniques may be considered to achieve an optimal result. In certain cases that cartilage is buckling and is causing nostril asymmetry, scoring in combination with suturing and grafting will provide an optimal results. If your physician is experienced and specializes in rhinoplasty, go for it. You should care for a good result, not how each small steps are taken to get your desired results.
Scoring technique for rhinoplasty
We do not recommend scoring techniques to nasal tip cartilages due to the unpredictability of the healing process. A wide boxy tip is treated with a combination of suturing the nasal tip cartilages and sometimes a conservative removal cartilage. Osteotomies are usually required after a hump removal. Please see the link below for examples of how we have addressed the boxy tip in our rhinoplasty practice
Scoring and rhinoplasty
when cartilage is scored it bends. it bends away from the scored side. so if it is straight once it is scored it will be convex on scored side and concave on the none scored side.
as to how scoring is going to be used in your case is any bodies guess.
scoring of the "tip" cartilages (domes of the lower cartilages) can make them weak and lead to deformities over time.
your photos is from a far away perspective but based on what i see, i would offer an open rhinoplasty.
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Could You Explain How the "Scoring" Technique Works in Rhinoplasty?
Scoring will weaken the cartilage to some extent and can make it more deformable. Sutures can help refine the tip. The specific technique is not nearly as important as precision and execution in the result. Find a plastic surgeon with ELITE credentials who performs hundreds of rhinoplasties and rhinoplasty revisions each year. Then look at the plastic surgeon's website before and after photo galleries to get a sense of who can deliver the results.
Kenneth Hughes, MD Los Angeles, CA
Scoring Cartiledge is for minor changes
Very hard to give opinion without better up close photos. That being said, thin skin is preferable in rhinoplasty patients. It allows for the changes (tip) to be seen. Endo nasal approaches are great for straight, hump only noses. The technique becomes significantly more difficult to use with good results in patients desiring significant tip work. Tip Cartiledge work in endo nasal surgery requires Cartiledge delivery techniques which can be unpredictable. Cartiledge scoring is good for minor changes to help straighten bent Cartiledge.
Best of luck!
Scoring cartilage means to make very small scratches into the cartilage to weaken, or break up the "memory" of the cartilage. This technique can be useful when combined with suture modification of the tip.
Scoring alone can have disappointing results
In my experience, scoring alone is not adequate for reducing the size of a bulbous, droopy, and boxy tip. The rationale is that by making a series of scratches, or cuts that don't go through-and-through the cartilage, you can weaken the cartilage to fold over somehow and look more narrow. But it's not predictable, or very controllable. Also, it can disturb the cartilage enough that in the not-so-unlikely event that you would seek a revision, the scoring of the cartilage can put a limit on the amount of improvement the revision surgeon can make.
And in the case of *shortening* a nose, I just don't think it can be done at all by scoring.
Did your doctor show you lots of before and after photos of his other patients where he made attractive changes in the width and position of the tip by using scoring? If not, you should stay away.