As the readers will see throughout this issue of Clinics in Plastic Surgery on abdominoplasty, some of the basic tenets of Dr Rosenfield’s technique (as with all the other techniques presented) are based on principles that are in complete opposition to principles of other techniques. For example, although the high lateral tension abdominoplasty technique that Dr Rosenfield describes and the lipoabdominoplasty technique described by Dr Saldanha in “Lipoabdominoplasty: The Saldanha technique” (elsewhere in this issue) espouse a limited supraumbilical dissection, they diametrically oppose each other when it comes to liposuctioning the supraumbilical flap. Dr Rosenfield feels strongly that liposuctioning the minimally undermined flap is dangerous and should be avoided at all times, with the idea that “zero tolerance” of distal flap necrosis should be aimed for. Dr Saldanha not only espouses liposuction of the supraumbilical flap but also actually depends on it as an essential component of his procedure. Dr Saldanha feels strongly that the limited elevation, to just between the medial borders of the rectus muscles, makes liposuction of the flap safe. I leave it to readers to decide how they feel about this matter.

Another point I would like to address is Dr Rosenfield’s belief that a high lateral tension abdominoplasty can deliver a “true body lift effect.” Although I agree that the vector forces created by the procedure do create improvement in thigh contour that may not be realized through more traditional techniques, I disagree that a significant improvement in lower back and buttock contour occurs. I believe that the improvement in thigh contour usually requires extending the scar past more traditional anterior-only bounds. Like Dr Rosenfield, I also believe that it is necessary to address these issues and that if extending the scar is necessary, it is not a bad compromise as long as the patient is aware of it (see Figs. 11–13 in Dr Rosenfield’s article).

“High Tension Abdominoplasty 2.0” by Dr Lorne Rosenfield in this issue of Clinics in Plastic Surgery describes the details of high lateral tension abdominoplasty. Dr Rosenfield has taken Dr Lockwood’s philosophies and principles and further refined and elucidated them. He not only describes his technique but also gives his reasoning behind each step.