Commentary

Dr. Dean Toriumi shares with us some of his favorite techniques and furnishes an uncommon wealth of detail in a relatively short piece. I will comment on some of the points that I found particularly useful, but there is little to add to this masterful presentation.

Meticulous maintenance of the dissection plane deep to the perichondrium and periosteum is fundamental to preserving the vascularity of overlying soft tissues. The transition zone, from the cephalic border of the alar cartilages to the dorsal septum and upper lateral cartilages, requires special attention to preserve the proper plane of dissection as the soft tissue flap is elevated.

In his description of the tongue-in-groove technique, Dr. Toriumi says that you can shorten a hanging columella without resecting vestibular skin. Amen! Nonresection of skin respects a fundamental plastic surgery principle—preservation of blood supply. If the supporting skeletal elements are properly positioned, the soft tissues will shrink to the underlying support.

Dr. Toriumi's throwaway line, “I prefer a higher dorsal profile, so I am conservative when it comes to dorsal hump reduction,” should be imprinted in the brain of every resident contemplating the aesthetic fundamentals of rhinoplasty and preparing to first perform this challenging operation. Attention to lip length and the lip/tip ratio when contemplating columella reduction or enhancement is another important but sometimes underappreciated aesthetic consideration.

Dr. Toriumi's advice on limiting shield-type tip grafts to patients with thick skin is basic but sometimes underappreciated. His tips and tricks for camouflaging shield grafts are a rather complete primer in successfully using this demanding technique.

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On a personal note, this issue of the Journal ends my 3-year term as associate editor of the Operative Strategies column. It has been an uncommon pleasure to work closely with my colleagues in the planning and editing of their articles. I learned much in the process and want to thank all of the contributing authors for their hard work and outstanding efforts on behalf of our readership.

I am particularly pleased that Dr. Foad Nahai will replace me as editor of this column. He offers a singular combination of comprehensive clinical knowledge and editorial skills that is sure to enhance future Operative Strategies.

Serving as editor of Operative Strategies is one of the most challenging positions on the Editorial Board .Aesthetic Surgery Journal is indebted to Dr. Pitman for the countless hours and exceptional insights that he has contributed to this column.

Stanley A. Klatsky, MD, Editor in Chief