Why won't my surgeon do a morph for a revision?

I also agree with Dr. Webster.  Morphing the nose pre-operatively is used to present a simulation of the results post-operatively.  It is a tool used to verify the goals of patient and surgeon.  Morphing of the lateral (side) view, is much simpler to create than a frontal view.  That is probably the main reason the frontal view is not morphed.  I recommend an open discussion with your primary surgeon, before changing physicians.

In general, a computer morphed photo serves the following purposes:



1) To give the patient an idea of how the final result of surgery may appear


2) To serve as a goal for the surgeon to follow in the operating room



Every surgeon has their own individual protocol they follow. Some use computer morphing and others do not. Your surgeon may be perfectly capable of doing a great job, but may not want to use the morphing for whatever reason. This may be a red flag, but not the determining factor of your surgeon's capability. Did they explain to you what would be performed during a revision? Are you confident they will be able to fix your nose and this will be the final surgery? If not, a second opinion may not be a bad idea. I hope this helps, and I wish you the best of luck

Morphing for rhinoplasty is a great tool for communication between plastic surgeons and patients, however, it has its limitations. Front view is somewhat difficult to morph and depends on the quality of photos taken in the office. Fine changes may be impossible to depict on the front view. Also, it is a personal choice of surgeons when to use morphing and is not necessarily the standard of care, although most colleagues i know do use it routinely. 

Grigoriy Mashkevich, MD

New York Facial Plastic Surgeon

 

In the past I used to never image and morph revision rhinoplasty. The frontal view is the hardest. However, I find now that imaging is great for revision surgery. A lot of what we do for revision surgery are set goals for what we are looking to achieve as well as discuss what can and can't be done; even more than primary surgery. I don't give out the photos though for revision surgery since it's a discussion tool and may be less accurate than morphing for primary surgery.
 

You ask a good question.  Morphing is a communication tool, not a guarantee of a result.  The problem with front view morphing is that it just isn't very good yet, in terms of how the final result might look. It's great for profile however.

My suggestion is:  Talk with your surgeon and be as specific as possible about what you would like, at each level of the nose - upper, mid and lower / tip. Ensure your aims are realistic.  Discuss the proposed plan to achieve a realistic, reasonable and agreed aim for the revision surgery.

If you feel that the  communication and agreement between you and your surgeons is right - that is both of you feel that you are in agreement, and the proposed revision is realistic - then the morph is redundant and you will likely do very well.  Ergo, a morph but poor communication between you and your surgeon will not get you where you want to be.

Hope this helps.  The question to ask is really:  why not do a morph?  and if the answer is that a realistic impression of the new result cant be conveyed through that technology, then that is a reasonable answer.

All the very best.

Howard Webster

 

Computer imaging can be helpful, but it is important to understand that someone who is competent with the computer can draw anything.  They can draw a perfect result.  The experienced surgeon with computer imaging will only draw what can be realistically obtained with surgery.

I do not use computer imaging for primary or secondary rhinoplasty. I think that sometimes patients feel that it will give them the exact result shown, but in reality the soft tissues do not respond exactly as shown in a computer image. 

  Computer imaging is simply a communication for surgeons and patients to use to give an idea of what the nose might look like. Be very specific in your communications with  your surgeon to  make sure both have  a clear understanding of the limitations and expectations of revision rhinoplasty surgery, since it is quite difficult.

Using of technology is a personal choice for surgeons. Choosing to do it, or not is a personal decision. 

In my practice I use it a s a communication tool between patients and myself. I always do the morphing, as I believe it is important for visual communication about what the surgeon can achieve, and what the patient expects.

Your plastic surgeon's response is not necessarily a "red flag”. Best to run your questions and concerns by your plastic surgeon; online consultants will only be able to speculate as to what his reasoning may be.

 Remember that imaging technology is not used as a “guarantee” of results but is simply a form of communication. Ultimately, you will need to feel comfortable that you and your plastic surgeon have  communicated sufficiently and that you are both on the same page as to what the goals and expectations are.

 Best wishes.