How Computer Imaging is Changing the Ways Surgeons and Patients Communicate
By Richard Rival

Rhinoplasty, although it is among the most commonly performed cosmetic procedures, is particularly challenging in terms of patient satisfaction and surgical execution. Often, it may seem like patients and surgeons are speaking different languages, hearing but not understanding one another. Patients have a difficult time expressing exactly what they dislike about their nose and how they would like it improved while surgeons can find it similarly challenging to explain to patients what kind of results are possible. Many surgeons are attempting to improve patient satisfaction by using computer imaging to outline possible results and, more importantly, ensure that surgeon and patient have similar expectations.

As these computer imaging technologies become used more frequently for my nose surgery patients in Toronto, it may be helpful to explain the benefits and limitations so that patients and surgeons alike understand this potentially useful tool.

Use of Computer Imaging for Rhinoplasty Procedures

Facial features are unique to each individual, arguably more unique than other physical attributes such as body shape or breast size. The nose, as one of the most prominent facial features, can be central to overall beauty. Surgery to improve the size or shape of the nose is a very delicate procedure, as the smallest alteration can make a significant difference. There are a variety of visual factors to be considered when people choose nose surgery:

• Nose size
• Nose width
• Bumps or depressions on the bridge of the nose
• Whether the tip is large, drooping, or upturned
• Size and shape of nostrils
• Asymmetry

In the past, the only way for a surgeon to visually demonstrate possible results would be to draw a diagram or to take a photograph of a patient's face and then draw on the photograph. Computer imaging (or "morphing") requires the surgeon to take several photographs of a patient's face, but instead of writing on the photographs, the images will be manipulated on a computer screen. These altered photos show how surgery can revise the appearance of the nose and how any changes will affect the overall appearance of the face.

Can Computer Imaging Predict Rhinoplasty Results?

In an article that I co-authored (entitled "Digital Imaging in Rhinoplasty" and published in May 2009 in the journal Aesthetic Plastic Surgery), my colleagues and I detailed the results of a study that was conducted to determine if computer imaging was useful in predicting rhinoplasty results. For the study, patients undergoing rhinoplasty procedures were provided with preoperative computer imaging. Eleven months after their procedure, these same patients and their surgeons were asked to compare the results of the rhinoplasty procedure with the images provided by the computer imaging program. Surgeons were not allowed to evaluate their own patients in order to eliminate any possible bias. We discovered the following:

• Both surgeons and patients felt that the images were predictive of actual outcome for approximately 75% of the cases.
• In general, the lateral (side view) preoperative images resembled the actual surgical results most clearly. Frontal images, although perceived as slightly less accurate, were considered predictive as well.
• Conclusion: In the majority of cases, computer imaging is a strong predictor of rhinoplasty results.

Ethical Concerns

Although my research indicates that computer images can be useful in predicting the results of rhinoplasty procedures, there are some ethical factors to take into consideration. There is no way to predict with absolute certainty how each person's nose will heal after surgery; each person responds differently. Because a computer cannot evaluate these unknowns, I explain to my nose surgery patients in Toronto that the images are not a promise of results but serve as a guide to general surgical goals. It is important that patients not interpret these images as guarantees and thereby develop unrealistic expectations.

Guidelines for Use of Computer Imaging

Here are some general guidelines for patients to keep in mind when examining computer images for rhinoplasty procedures:

1. Ultimately, computer imaging should be used to facilitate a conversation between you and your surgeon so that you know you are both working toward a common goal.
2. The images produced can be a guide to help develop your concept of how you would like your new nose to look and give you an idea of how a surgically-altered nose will fit with your other features; the images are NOT a guarantee.
3. Be wary of surgeons who use computer images as a "selling tool," showing you a picture of a "perfect" nose and promising a perfect outcome. An ethical surgeon will be honest and realistic about what rhinoplasty can accomplish for you.
4. Depending on the adjustments to be made, lateral (side view) morphed images may be more useful in predicting your rhinoplasty results.
5. Be sure to choose a surgeon who has the education, training, and experience to make the results of your nose surgery as close as possible to those produced by computer imaging. I suggest checking to see if your surgeon is certified by the American Board of Facial Plastic and Reconstructive surgery, the only board that  focuses exclusively on cosmetic and reconstructive surgery of the face and neck.
6. Ask to see before and after photographs of your surgeon's former patients to see what kind of results they have actually been able to achieve.
7. It may take up to a year for the results of your rhinoplasty to be clearly visible, so be patient if your results aren't immediately apparent.

With computer imaging, men and women are able to participate more completely in the process of planning their rhinoplasty. Instead of hoping that your surgeon's vision for your rhinoplasty is in tune with your own, you can use computer imaging to be certain that you are on the same track. While computer imaging cannot provide guaranteed results, it can provide peace of mind that you have been heard and understood.

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