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Letter to the Editor - Year2020 - Volume35 - Issue 2

Mr. Editor,

We read with great interest the article with the title: “Increase in the projection of the nasal tip with ‘pseudo-flaps’ obtained from excess cephalic alar cartilages” by Bozola et al. in 20191, published in the Brazilian Journal of Plastic Surgery. The authors describe a different technical approach to the projection of the nasal tip, using the resected cephalic portion to reduce alar cartilage in rhinoplasty. The concept of using the alar cartilage itself for reuse in the nose area, as reinforcement of alar cartilage2, in use as an expander graft3, in the back filling4 or the filling of the soft triangle region5 has been described in the current literature and we believe that its reuse, in rhinoplasty techniques, is the ideal way.

According to the description of the results, we would like the authors to comment on the following questions regarding this article:

    First: An increase in the projection of the nasal tip was observed. What was the instrument used to compare and evaluate the projection objectively?

    Second: In increasing the nasal projection, we have several techniques used with sutures and use of grafts, in addition to the technique described, which other techniques were used together in the patients studied?

    Third: In the description, patients reported a satisfactory result. Which instrument was used to measure the pre and postoperative evaluation of these patients?

Finally, we congratulate the authors for their work and innovation regarding the rhinoplasty technique.


1. Bozola AB, Bozola AC, Sommer CG. Aumento da projeção da ponta nasal com "pseudo-retalhos" obtidos dos excessos cefálicos das cartilagens alares. Rev Bras Cir Plást. 2019; 34(4):445-51.

2. Racy E, Fanous A, Pressat-Laffouilhere T, Benmoussa N. The modified sliding alar cartilage flap: a novel way to preserve the internal nasal valve as illustrated by three-dimensional modeling. Plast Reconstr Surg. 2019 Sep;144(3):593-9.

3. Uebel CO, Matta R. Alar cartilage-an alternative for spreader graft in primary rhinoplasty. Eur J Plast Surg. 2017;40(5):417-26.

4. Kreutzer C, Hoehne J, Gubisch W, Rezaeian F, Haack S. Free diced cartilage: a new application of diced cartilage grafts in primary and secondary rhinoplasty. Plast Reconstr Surg. 2017 Sep;140(3):461-70.

5. Campbell CF, Pezeshk RA, Basci DS, Scheuer JF, Sieber DA, Rohrich RJ. Preventing soft-tissue triangle collapse in modern rhinoplasty. Plast Reconstr Surg. 2017 Jul;140(1):33e-42e.

1. Centro de Reabilitação Henrique Santillo, Plastic Surgery, Rhinoplasty, Goiânia, GO, Brasil.
2. Hospital de Clinicas UFG, Cirurgia Plástica, Goiânia, GO, Brasil.
3. Hospital Estadual de Urgências Governador Otávio Lage de Siqueira, Cirurgia Plástica, Goiânia, GO, Brasil.

Institution: Hospital de Clinicas UFG, Cirurgia Plástica, Goiânia, GO, Brazil.

Corresponding author: Fabiano Calixto Fortes Arruda R. T-50, 723 - 07, St. Bueno, Goiânia, GO, Brazil. Zip Code: 74150-170 E-mail:

Article received: February 18, 2020.
Article accepted: May 02, 2020.

Conflicts of interest: none.

Dear Reader,

In clarifications to the questions requested regarding the article “Increase of nasal tip projection with pseudo flaps obtained from cephalic excesses of the alar cartilages”:

    First: The instrument used for comparison were the photos of Pre and Postoperative profile.

    Second: The patients studied were initially submitted to the tactic described without using other procedures.

    Third: The instruments used for the analysis of the results were the clinical examination and photos as reported and also the evaluation of the patients themselves. Metric measurements were not used in any of the cases.

1. Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, SP, Brazil.


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