Could You Explain How the "Scoring" Technique Works in Rhinoplasty? (photo)

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!

Doctor Answers 7

Scoring tehchinque in rhinoplasty

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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.

Orange County Facial Plastic Surgeon
5.0 out of 5 stars 224 reviews

Scoring technique for rhinoplasty

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  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

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 158 reviews

Scoring and rhinoplasty

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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.

Adam Bryce Weinfeld, MD
Austin Plastic Surgeon
4.9 out of 5 stars 63 reviews

Could You Explain How the "Scoring" Technique Works in Rhinoplasty?

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     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

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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!

David Shifrin, MD
Chicago Plastic Surgeon
5.0 out of 5 stars 178 reviews

Scoring cartilage

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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. 

Matthew Bridges, MD
Richmond Facial Plastic Surgeon
5.0 out of 5 stars 26 reviews

Scoring alone can have disappointing results

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Hi, Sissi,

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.

Steven M. Denenberg, MD
Omaha Facial Plastic Surgeon
4.8 out of 5 stars 42 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.