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Steven M. Denenberg, M.D.
Steven M. Denenberg, M.D.
chin augmentation
 
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Many of the books that talk about classic proportions of the face describe how strong the chin should be.  Here's the guideline most books mention: on the profile view, find the lowest point on the lower lip where you would place lipstick.  Draw a line vertically down from that point.  The chin should come forward to touch that line.

However, guidelines are just guidelines.  Put a ruler on your computer screen, and you'll see that, even in the after picture, her chin doesn't come forward to that theoretical line.  And we would not want to make her chin any stronger than it already is.  Often, the best surgical plan is to attempt a good improvement, and not strive for some generalized goal that might not work on everyone.


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Next: an example of the solid advice Dr. Denenberg gives patients on RealSelf.com.
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Questioner: Could You Explain How the "Scoring" Technique Works in Rhinoplasty?
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!
(Questioner submitted photos)

Dr. Denenberg's answer: Scoring alone can have disappointing results
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.

Link to this question on RealSelf.com



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