Rodolfo Borsaro Bueno Jorge

Rodolfo Borsaro Bueno Jorge

Federal University of Ceara, Brazil

Title: Important surgical steps in the primary rhinoplasty to prevent deformities of the alar rim


Rodolfo Borsaro Bueno Jorge has obtained Medical Residency in Otolaryngology and Facial Surgery Cervico in the Faculty of Medicine of São José do Rio Preto, São Paulo. He is member of the Brazilian Academy of Facial Plastic Surgery (ABCPF), Member of the Brazilian Academy of Skull and Maxillofacial Surgery (ABCCMF) and Member of the Brazilian Academy of Otorhinolaryngology/Neck and Facial Surgery (ABORLCCF). He is preceptor of facial plastic surgery of Otorhinolaryngology discipline of the Federal University of Ceará, Co-ordinator of ENT emergency São Carlos Hospital, President of the Medical Ethics Committee of the São Carlos Hospital (2016-2018). He is developing a Doctorate project in the University of São Paulo (USP Ribeirao Preto, SP). He has also written book chapters related to otoplasty and rhinoplasty and some scientific articles. He is former financial Director of Otolaryngology of Ceará State Cooperative (2008-2012).


The ideal alar rim is oval shaped with a smooth contour, framed by the superior nostril border above and the columellar roll below. It is important a smooth transition between the tip complex and the alar lobule, otherwise, an undesirable shadow that isolates the tip can occur which increases the visual prominence of the tip. Alar rim deformities are one of the most common problems encountered in primary and secondary rhinoplasty patients. Congenital malpositioned lateral crura or from overaggressive surgical manipulation of the lower lateral cartilages and alar rim deformities can have both functional and aesthetic consequences. According to the distance from the long axis of the nostril to either the columella or alar rim, the deformities may be: hanging columella, retracted ala, hanging ala, retracted columella or miscellany. More recently, the extended alar contour graft has been used to prevent notching of the anterior alar rim where the lateral crus begin to diverge from the alar rim as it courses to the piriform aperture. Multiple techniques of varied complexity have been described to treat and to avoid this common and challenging problem. The steps are: (1) Infracartilaginous incision in “ V” (2) Hemitransdomal cephalic suture (3) Minimal resection of lateral crura cephalic margins (4) Improving support of the lateral crura through the “turn in or turn over flap” (5) Horizontal rotation of the lateral crura (6) Different suture of the infracartilaginous incision (7) Rim graft. The objective of this presentation is showing and discussing these important steps to avoid this alar retraction and airway obstruction from collapse of the external nasal valve and preserve the natural contour of the alar rim, thereby improving alar symmetry.