Q: Dr. Eppley, Thank you for your rhinoplasty consultation and doing some computer imaging for me. Now that I am moving forward with actual rhinoplasty surgery can you send me the exact prediction images of my nose results? That will help me understand what I can expect after surgery.
A: There is no such thing as ‘exact prediction images’ in rhinoplasty or any other facial surgery. Prediction imaging is done as a communication method between the surgeon and the patient to determine what changes the patient desires and to make sure what may be possible is in line with the location and extent of changes the patient wants. They should not be interpreted as exact replicas that surgery may achieve nor are they guarantees of the result that would be obtained. They are estimates as to what the surgeon believes may happen but can not take into account the exact anatomic changes they would be done nor the effects of healing on these surgical changes. Therefore one should appreciate the term ‘prediction images’ when it comes to this important presurgical step. Fortunately it is usually more accurate than predicting the weather but the accuracy of rhinoplasty prediction imaging depends on the surgeon doing it.
Dr. Barry Eppley
Q: Dr. Eppley, How accurate is computer imaging for various facial surgeries? I have had several plastic surgeons do imaging for a future rhinoplasty and it is interesting that are significant differences between what they show. It is hard to know what is realistic. I thought computer imaging would show a very accurate result. So why are these plastic surgeons imaging results so different?
A: While computer can take a picture and change a facial feature like a nose, the only way the software knows what to do is based on who is controlling the mouse. In essence, computer imaging is a reflection of what the plastic surgeon THINKS he/she can achieve. They are showing the type of changes they want to illustrate to you presumably based on their experience…and hopefully it is a reflection of what is likely to occur in their hands.
Therefore it is important to understand that facial computer imaging is a prediction…and hopefully that prediction can be achieved by actual surgery.
What I try to show in computer imaging is the MINIMUM result that I think can be achieved as that should be the basis of what motivates one for surgery. More may be able to be achieved but that should be viewed as a ‘bonus’ and not the basis of one’s satisfaction with the result. This becomes critically important in an aesthetic operation like rhinoplasty which is highly scrutinized by the patient afterwards.
Dr. Barry Eppley
Q: Dr. Eppley, I am considering some facial surgery to improve my overall aesthetics. I have previously been through a rhinoplasty, chin implant and cheek implants. While these have been helpful, I still want to get better results. I am hesitant in doing any more surgeries, however, unless the results will be a significant improvement in facial aesthetics and symmetry. To help me visualize what I want I have used a facial aesthetic program which morphed the “ideal male ” with mine. The pictures seem to make the chin width smaller and less square and with an even jawline to the posterior angle of jaw. The images seem to downsize the cheek implants and to make the tip of nose more symmetrical and smaller with a raised nasion. I have attached a few of these pictures. The first two pictures are that of an ideal female face with mine. The last three are the ideal male face combined with mine. Thirty points on my face were used for my facial proportions to generate these pictures. Is it possible to achieve this morphed look since it seems the resulting face is more aesthetic.Your thoughts and concerns are greatly valued regarding what is achievable. If you have a software program regarding what the postop look will be regarding the different procedures I would be interested in seeing those results.
A: Thank you for sending your images and your thoughtful morphing overlays. While I think they are helpful to see what direction you ideally want to go, I do not find them realistic or that those type of results are achievable. Images like this set the standard of how the patient will judge their outcomes afterwards and it always leads to results that fail to hit the mark and are disappointing. Their greatest value lies in helping the patient determine whether surgery is worthwhile, particularly the patient who has been through previous surgeries and is in the ‘revision mode’. Quite frankly, I and probably most plastic surgeons shutter when a patient goes through this exercise because the results will always fall short. Since I do not feel your results would meet these imaging goals, at least in my hands, I would recommend that revisional plastic surgery may not be worth the expense and recovery.
Dr. Barry Eppley
Q: Hello there… I was curious on whether you dabble in computer imaging for let’s say a jaw enhancement procedure. Thanks.
A: When considering structural facial alterations, as opposed to age-related changes, it is extremely important for the patient to have a reasonable idea as to what their face may look like. For this reason in my Indianapolis plastic surgery practice, I never do such facial surgery without computer imaging before surgery.
Several points about computer imaging, however, are important for patients to understand. First, facial computer imaging is a prediction but not a guarantee of results. It is the plastic surgeon’s best estimate of what he or she thinks may happen. But plastic surgery is not like Photoshop. How the body heals and responds to surgical manipulation of its tissues is not precisely predictable. Think of computer imaging as a communication tool primarily. It helps ensure that what the patient finds acceptable is surgically possible.
Secondly, the most predictable facial features to image are those that can be done in profile. With a contrast between flesh-colored skin and a solid color background, it is much easier to change the feature in a more precise manner. Therefore, procedures that change the brow (brow bone reduction), nose (rhinoplasty), chin (chin augmentation/reduction), and neck (liposuction, facelift, tracheal reduction) can be imaged with reasonable realistic accuracy. Certain frontal (face forward) structures can also be done, such as the ears and lips, but most of the face is this view do not have good color contrast between adjacent parts.
Last, if you can not get computer imaging for these types of facial plastic surgery procedures…go find another plastic surgeon.
Dr. Barry Eppley