Morphs versus reality, how close is a doctor able to get to the morphs?

Question

Hi Doctors, After 3 rhinoplasty consults. I am only getting morphs of the profile and not the front view. I cannot get a grasp on the degree of correction to expect on my crooked nose. I cannot get any doc to give me a clear answer on how close results will come to the morph image. I really need assurances before undergoing such a transforming procedure. Any advice? How close are you able to get the actual result to the morphs typically?

Adam Bryce Weinfeld, MD · Answer

It is difficult to give you a solid answer on this.  Morphing your photo on a computer can give a good approximation of what can be achieved in reality.  That being said, it is just that, an approximation.  There is no way to guarantee how your results will turn out as there are many other factors involved such as skin thickness, scarring, underlying nasal anatomy, etc.

Gene Sloan, MD · Answer

Typically when we morph nose images for patients, we tend to underdo it so as not to give false promises.  Anyone can make your nose perfectly straight on front view with morphing or Photoshop software.  However the real question is whether that can be achieved surgically.
I believe you would be better served by viewing before and after photos of crooked noses on the surgeon's website and choose accordingly.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Morphs do not necessarily predict what your surgeon is capable of. Make sure you specifically look at before and after pictures of real patients who have had this surgery performed by your surgeon and not just a computer animation system. You should be able to view numerous pictures of actual patients with noses similar to yours performed by your surgeon. If you cannot find enough real before and after pictures, then consider continuing your search for a surgeon. Best wishes and good luck.

Richard G. Reish, M.D. FACS

Harvard-trained plastic surgeon

Richard G. Reish, M.D. FACS

Harvard-trained plastic surgeon

Michael A. Persky, MD · Answer

Hi tk,Great question.  We computer image all of our patients with two different software systems.  Anyone can "photoshop" a nose, we pride ourselves in imaging our patients noses in a way that is achievable in the operating room.  It is necessary to know what changes are surgically possible and desirable and then share them with you.  We can show you many patients whom we have performed rhinoplasty upon, their pre-op photo, their imaged photo, and lastly their post-op photo side by side.  When done properly, computer imaging for prospective rhinoplasty patients can be very helpful and accurate.  Rhinoplasty is an art and science, one of the most difficult of all plastic surgeries.  You should consult with multiple rhinoplasty experts and then choose your surgeon carefully based on their training, skill, experience, knowledge, and most importantly their natural artistic vision.  A few rhinoplasty experts I would recommend are Ari Hyman, MD (Los Angeles), Dean Toriumi, MD (Chicago), and Steven Pearlman, MD (NYC).  Good luck and be well.Dr. P

Eugene Kim, MD · Answer

There is no guarantee that you will achieve the "morph" result with rhinoplasty.  Unfortunately surgery doesn't work that way.  I prefer not to provide morph images in my practice for that reason.  Instead I show patients photos of the previous work I have done in patients with similar issues so they have an idea what to expect.

Gerald Minniti, MD, FACS · Answer

Digital simulation is a communication tool to align the surgeon with the patient's vision. It is not a guarantee of how it will actually look, but an assurance that the doctor will be working toward the patient's goals during the surgery. I perform it during the consultation live with the patient, and show multiple views. If someone requests a particular view, I create it. I don't understand, did these doctors deny you?

Ronald J. Edelson, MD · Answer

Computer simulation just works better for the profile. Not very useful for front on views. As far as the asymmetry you mention don’t be surprised to get different opinions on what to do because straightening a crooked nose can be difficult.

Samuel Lin, MD, FACS · Answer

Great question- I believe that imaging could be helpful in cases; nonetheless, from a frontal view I believe it to be a challenge to show a 3 dimensional image on a 2 dimensional photo- there is a degree of limitation of a morphing program to show a frontal view on some level... I think that actual photos of patients before and after are the best representation...

Daniel Zeichner, MD · Answer

Hi and welcome to our forum!
Photoshop or any imaging alteration software rearranges or deletes pixels on a computer screen. Rhinoplasty involves surgical manipulation / modification of bone, cartilage, and skin, which may be limited by certain anatomic features, postoperative warping of cartilage / bone or inadequate correction necessitating a secondary touch up, or the presence of thickened skin, An altered photograph provides the DESIRED result, but not necessarily an achievable result. It is used by some to provide a "rough estimate" of what can be accomplished. It is of more value to view the physician's pre and postoperative rhinoplasty photographs.
From a legal standpoint, the photograph may be considered an "implied guarantee". It isn't...
Best wishes..

Jeffrey Jumaily, MD · Answer

That's a very good question and often asked by patients. The simulation is done on a computer software. The surgeon can really control how to change the shape. As a surgeon, I can make the nose look any way I want, however, that does not mean that it is possible in reality. For example, a patient with thick skin who wants their nose shorter. You can make a simulation photo where the nose is shorter and more defined. In reality this is not possible because if you make the nose smaller in thicker skin patients, the definition of the tip will suffer. Therefore, a doctor should not simulation that because it is not achievable. The profile view is the most useful view. The changes are clearly visible and realistic. Front view is the least realistic. On front view, the highlights and contours of the photo are complex and simulation cannot replicate them exactly especially with crooked nose. there is newer software that could address these issues. Hope this helps.Best wishes.