Dean's App

Useful content; registration and UI need improvement

While the content is this app is very useful, the registration process is quite inefficient and takes about a month before you have access to the app (have to email your profile picture, credentials, etc). Would be nice if we could just use the activation code in the book to get immediate access. Also can only use on one device. Not sure if all the content is added/accurate There are some parts of the textbook that take you to Dean’s app but then when you click on the app module there’s no content; just keywords. Would also like support for the app to be used in landscape mode for the iPad. Currently you have to use it in portrait mode.

The Authority in Rhinoplasty

As one of Dr. Toriumi's Fellows, I certainly appreciate that I have a unique perspective. I get to assist him on all of his cases where I have the ability to ask unlimited questions and learn his techniques, first-hand. Since the advent of his multi-volume book, rhinoplasty surgeons around the world can now similarly delve into the mind of a true master surgeon. His book is meant to be read cover-to-cover alongside of his mobile application - Dean's App - in order to fully appreciate the evolution and implementation of his approach. And, it should certainly be referenced time-and-time again as there are many intricacies that may not be grasped by the reader the first time. Although there are many, I'd like to emphasize just a few aspects of the book where special attention should be paid: Photography - As many know, social media is rampant with pre and postoperative patient photos which have different lighting, angles, and emphasis. This makes comparison of results very difficult and, if used inappropriately, can be misleading to patients. In his book, Dr. Toriumi details his choice of camera, lighting, and overall approach to photography of the nose. Take the time to learn and invest in serious photography equipment. Intraoperative photos are shown to provide evidence of exactly how each technique is utilized and what the structure looked like prior to completion. This is incredibly important as I have found myself wondering exactly what something looked like even 2 weeks after an operation when I didn't take photos. There is an ample amount of photos that can be studied in his book which demonstrate such standardization, objectivity, and opportunity for insight. Although we take sometimes hundreds of photos on each patient - pre, intra, and postoperatively - this isn't necessary or practical for most surgeons. Instead, find a series of views that can be taken over time to see how things change - for better or worse. The reader will find this consistency rewarding and also humbling. Caudal Septal Extension / Replacement Grafts - During my Fellowship, this was the most difficult graft for me to conceptualize and implement in practice. At minimum, this graft alone controls three variables - projection, length, and rotation - and helps set the entire foundation for the structure of the nose. In his book, he has an excellent chapter which details the different types of this graft which can be made to control these variables. Take the time to look at the nuances in the carved shape of each and how it changes the pre and postoperative patient photos. In practice, measure the size of the graft and visualize how parameters change like length, rotation, and projection once secured. Look carefully at his usage of cartilage / bony splinting grafts to straighten and provide stability. Be sure to realize the importance of setting the crura caudally on this graft to avoid overroration. He is meticulous with his suture placement and the reader should study this especially within his videos in Dean's App. Master this technique of grafting to create a natural nose. Cases - The last two chapters of his book are my favorite. Although there are case examples throughout prior chapters, the last two should be studied only after the reader has finished all topics and techniques. The reader must understand the basics, first. These cases are where a systematic and critical approach to rhinoplasty is discovered. Although each case has a primary focus, I would encourage the reader to view them all as many techniques have multiple applications. The reinforcement of these techniques is critical which is why repetition is helpful. The videos are excellent quality and there are many pearls discussed by Dr. Toriumi which are not included within the text. This textbook is truly the ultimate source for rhinoplasty, It provides an unadulterated look at the challenges, and rewards, that rhinoplasty affords from the perspective of the best. This book has provided a solid foundation for my future practice and will for many others. I encourage all readers to reference this book often in order to improve his or her skill set and outcomes.