Q: Dr. Eppley, I know that a lot of plastic surgeons use computer imaging for facial surgery. What I don’t understand is how do they know what is really going to happen since surgery and healing doesn’t work like a computer. How do I know I will get what the doctor has shown me by imaging?
A: From my perspective, the role of computer imaging in plastic surgery is different than how you are interpreting its use. It is mainly a communication tool to see if the direction of the various changes are what the patient sees as beneficial. It does necessarily guarantee any result nor the magnitude of the changes that may occur. (lesser or greater) This is why I am always going to image conservative changes or the very minimum that I believe that can be accomplished. I want patients going into surgery knowing that they will at the very least see these changes. More change may likely happen but it would not be very fair or ethical to show dramatic imaging if that is not what is surgically possible. Anything can be done on the computer but it is up to the plastic surgeon to not overpromise what can be accomplished.
Dr. Barry Eppley
Q: I tried to do some computer imaging of my face on some programs that some plastic surgeons have but it didn’t seem to work. I just couldn’t make it look right. I am interested in jawline enhancement and facial implants and was looking for some advice. I have attached some pictures for you to review and image.
A: An increasing number of websites, plastic surgeons and otherwise, and smartphone apps have interactive programs in which to do some of your own computer imaging of your face and body. By simply uploading a picture or two, you can do a little ‘Photoshop‘ plastic surgery. While these programs are certainly cool and fun, they are not particularly accurate. That is because of the simple fact that the ‘driver‘ has no realistic appreciation of what can really be done and what actually will happen if certain procedures are done. Only a plastic surgeon can add that missing element if one wants to make the transition from fooling around to seriously considering becoming more than just manipulated pixels.
But there are a few patients in which even the simplest change just don’t seem to look right. That is because their facial anatomy is different and the basic rules of changes do not work well for them. That happens to be the case with you. Your underlying problem is that your lower face is too short for the rest of your face. This shortness affects both your lower and upper jaw. So when you try and just move the chin forward, it doesn’t look right. It makes the midface (upper jaw and upper lip) look retruded or back too far. That relationship would be impossible for you as a patient to figure out. What you really need is a treatment that can move both the middle and lower third of your forward. That could be either chin and paranasal implants or orthognathic surgery that moves both the upper and lower jaws forward.
Dr. Barry Eppley
Q: What is the name of the computer program application which allows a plastic surgeon to show anticipated changes prior to surgery?
A: Computer imaging, or predictive surgical outcomes, is a very useful tool in elective cosmetic plastic surgery. Its value is not in that the predictions are a guarantee of what the final results will be, but as a communication tool between plastic surgeon and patient. Through the exchange of predictive images, it is far more likely that the plastic surgeon will have a good idea as to exactly what the patient does, and does not, want to achieve by the proposed surgery. Some unhappy outcomes from plastic surgery are the direct result of a misunderstanding of what the procedure(s) could do. This type of complication can be avoided by good communication before surgery and computer imaging can help that important process.
While it can be used all over the body, computer imaging is most effective and predictive for the face. It is particularly good in profile changes, such as rhinoplasty, chin and neck changes and forehead contouring. Because it is morphing anatomy that is contrasted with a different color background, the changes can be very accurate in many cases. They are also quite easy to see and appreciate. Frontal face imaging is also very useful but it is less accurate as one is pushing around and changing colors of pixels that are more similar. It is very easy to overpredict outcomes (looks better than what can really be achieved) in frontal views and the experienced and artistic hand of the plastic surgeon is really needed here to avoid an exaggerated prediction.
There are numerous software programs out there for computer imaging of the plastic surgery patient. The most common and widely available one is that of Photoshop Elements.
Dr. Barry Eppley