Morphing images with rhinoplasty? (Photo)

Question

Do most surgeons utilize morphing technology to provide patients with an idea of what the new nose may look like? I had a consultation last week, and I didn't receive a morphed image. The surgeon did give a thorough explanation of what is needed. I want to make sure I find the best surgeon. I've had this bump since I was eleven, and I'm finally ready to follow through with surgery.

Steven M. Denenberg, MD · Answer

Click on the "Web reference" link, just below my response, or go here:
FacialSurgery.com/RealSelf/RealSelf_jmclain1.html
I made a computer morph of your nose, and an animation of the morph, to show the changes that are possible for your nose in truly expert hands.
You need much more than just taking down the bump. Your nose is very long, and the tip should be elevated, quite a bit actually, or your nose will look even much longer after surgery if only the bump is taken down.
Then, I reduced the amount of the inside of the nose that shows on the profile view, and I also moved the tip of the nose back closer to your face. I wasn't so sure what to do with the upper part of the nose, because it wasn't in the photo!In this business, a picture, even a morph, is worth a million words.
You should understand that the changes I demonstrated in the morph require advanced techniques, techniques that most plastic surgeons cannot handle.  Be sure to read the section in the "Web reference" link on how to stay out of trouble while searching for a rhinoplasty surgeon. You should only have surgery if you are able to make yourself very confident in your surgeon's skills. Read that page very carefully. Most plastic surgeons are quite poor at this operation, and I believe my advice will go a long way toward keeping you safe.
I'd love to hear what you think of the morph. Did it seem to address your main concerns?
Your nose is also a good example of why computer imaging is mandatory in rhinoplasty. You need to know exactly what the surgeon is planning to accomplish -- what features he thinks he can change, and by how much he thinks he can change them. When you see his goals, you'll know whether he has an eye for a beautiful nose, and whether he shares your opinion of what constitutes a beautiful nose. You'll also know whether the changes he proposes are enough to be meaningful to you, and whether he understands your wishes enough to address all of your priorities. But remember, you're not hiring him for his skills with the computer. The doctor must then show you his before and after photos to prove that he can actually accomplish what he draws on the computer.
In your case in particular, you need to find a surgeon who understands all of the issues I mentioned, and how they fit together, and who can actually accomplish them in surgery. 
Finally, at the *very* bottom of the Web reference page is a link to instructions on taking and sending photos that are comprehensive and useful for an online consultation like this, in case you'd like a more complete evaluation.

Mike Majmundar, MD · Answer

Most surgeons do not utilize morphing as part of their consults.  As a surgeon who has not had the software until recently, I can say that it is extremely useful in communicating with my patient their intended desires graphically.  Of course, it is only a simulation and does not predict surgical outcome but it does help the patient and surgeon 'get on the same page'.   Also, the simulation program doesn't know your particular nasal attributes such as skin thickness, pliability of your cartilages, septal deviation contributing to crookedness, cause of a nasal hump under the skin, etc., so though it can visually give you a good idea of what you would like, it doesn't necessarily correspond to what can be done during surgery or the final surgical result.  It is a great tool, along with a good exam and an experienced surgeon, to communicate your desires.

J. Kevin Duplechain, MD, FACS · Answer

Imaging is a valuable tool for patients and physicians during  Rhinoplasty consultation.  It can demonstrate b/a look at your nose before having the procedure.  It can also be enticing, and unlike surgery, has no limits.  It is important to also view actual b/a photos of noses similar to yours performed by the surgeon, to determine if your goals will be met.

Andres Bustillo, MD, FACS · Answer

Many surgeons that are proficient at rhinoplasty provide patients with a "morph" However, morphs are only as good as the surgeon is. While it is impossible to always get a result very close to the morph, it should be used more as a communication tool between the doctor and the patient.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question.  I always advise patient to place much more value on real before and after pictures of your surgeon's patients rather than simulated images.  Simulated images do not mean that your surgeon can actually accomplish that result.  Based on your
photograph, you may benefit from a tip refining rhinoplasty. Your surgeon can
accomplish this by trimming, suturing, and reshaping the cartilage in your
lower nose. You may also benefit from a cephalic rotation of your tip to turn
up your tip slightly and a conservative dorsal hump reduction.  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. The most important
aspect is to find a surgeon you are comfortable with. I recommend that you seek
consultation with a qualified board-certified plastic surgeon who can evaluate
you in person.
Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Mario J. Imola, MD, DDS · Answer

Many surgeons utilize preoperative computer simulation to help determine the patients goals and establish a virtual 'target' for the surgery.  Computer simulations are never a guarantee of any given result.Mario J. Imola, MD, DDS, FRCSC, FACS.

Sachin S. Pawar, MD · Answer

Hello! I think the majority of rhinoplasty surgeons use some type of computer simulation or morphing as part of the rhinoplasty consultation process. While computer imaging is a very useful tool to help facilitate communication with our patients and go over individual goals of surgery, I do caution my patients that it is much easier to move a computer mouse and make changes on a screen that it is to actually perform the rhinoplasty. Patients will have individual characteristics and anatomical features that may limit what is truly possible, and unfortunately, computer imaging technology cannot account for these constraints. With that said, I also have colleagues who are excellent rhinoplasty surgeons and choose not to offer computer simulations to their patients. I would not base your decision soley on that aspect, but instead with your overall impression and comfort with your surgeon, reviews, and before/after photos. Good luck!

Robert Graper, MD · Answer

Morphing is a very helpful tool to make sure that the patient and the surgeon are on the same page for the goals of the surgery. It helps plan the surgery and sets appropriate expectations. We have both the standard 2D imaging and Vectra 3D imaging. Just because your surgeon does not have these tools does not mean they are not a good surgeon. Good luck.

David Shamouelian, MD · Answer

Hello and Thanks for the Question. 
Most surgeons do not have the morphing technology. I enjoy using morphing technology with my Vectra 3D imaging system because it is an excellent tool to communicate expectations. It helps me give a glimpse of what might be expected and to effectively convey my aesthetic and see if it is in agreement with the patients desires. This produces more satisfying outcomes and happier patients. Its also a really fun and informative way to teach patients about the nose and rhinoplasty. 
Hope this helps and good luck

Dr David

Sean Freeman, MD · Answer

jmclain1, don't fall in love with computer imaging. Some of the worst revisions of other surgeons noses that I've redone have come from patients who based their decision on an image. What matters is what they can do in the OR; a computer cannot do surgery. Based on that see an experienced plastic surgeon that specializes in "only faces" and has a lot of good photos. See the video for more information and good luck!

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