Section of Plastic and Reconstructive Surgery
The University of Chicago
2913 N Commonwealth Dr, Suite 400
Chicago, IL 60657-6224
SHUMRICK ET AL have written a good article; it introduces an important method for analyzing aesthetic results. But there is a flaw at its core. The subunit principle is appealing, but other variables are far more important to the aesthetic success of nasal reconstruction: (1) thinning the flap correctly, (2) matching flap edges to the recipient site, (3) giving the flap a normal or beautiful contour with a shapely subcutaneous cartilage framework, and (4) bracing the flap's marginal scars with thin platforms of cartilage, especially along the alar margin. These are the things that determine success far more than the relatively subtle effect of the subunit principle. If these techniques are applied artistically, a normal nose can result even when the subunits are entirely ignored (Figure 1). Shumrick et al have wrongly attributed the entire success or failure of their cases to their use of the subunit priniple.
Burget GC. Modification of the Subunit Principle. JAMA Facial Plast Surg. 1999;1(1):16-18. doi:10.1001/archfaci.1.1.16