My Surgeon Doesn't Do Computer Imaging Should I Be Concerned?

Question

I called to get a consultation for a chin implant and the lady said the doctor doesn't do computer imaging? She said instead they draw a picture? Is the surgeon just not good enough or confident enough to provide the results? How can I figure out what I will really look like after surgery?

Michael R. Macdonald, MD · Answer

The easy answer here is that you should absolutely not be concerned if your surgeon does not use computer imaging.

	There are many changes that can be easily accomplished on a computer, but not so easily accomplished in living human tissue. In this way, computer imaging can set false expectations for the patient about what is truly surgically possible.

	I used computer imaging early on in my practice as an excellent communication tool to help understand my patients' goals, particularly with rhinoplasty. However, after almost 20 years in practice, I now have so many examples of real life patient before and after pictures that I prefer to show prospective patients what can be accomplished in real life.

	In this way, not only can patients view improvement goals and results of other patients that are similar to them, but they can also get a broad sense of how patients respond to a particular type of surgery. Further, they get a sense of my surgical style and whether or not it suits them.

	In my experience, this real-life approach yields a patient who is better informed and whose expectations better match reality...as such, they generally tend to be more satisfied with their results.

Thomas Buonassisi, MD · Answer

Computer imaging is a communication tool that your surgeon uses to show you the possible changes that can be made to your chin. It allows for feedback from you the patient as to your likes and dislikes. If your surgeon prefers to show you the proposed changes through drawing on your pictures, that seems very reasonable. Its the skill of the surgeon and their ability to communicate to you what to expect from the surgery that counts.

William Franckle, MD, FACS · Answer

3d Computer Imaging is a relatively new technology that is making its way into plastic surgery practices.  Many qualified plastic surgeons have been performing surgeries and getting successful results/happy patients for years.  I use the Vectra 3D imagers as part of my consultation. However, this device does not perform surgery.  It allows the patient and the surgeon to look at a picture and agree that it is the result the patient is looking for and a result the surgeon can achieve. As with any surgery no one can guarantee that the manipulated image will exactly represent the final result. 

	As a prospective patient I would be more concerned regarding my surgeon&rsquo;s qualifications (board certified by the American Board of Plastic Surgery, member in good standing with the ASPS) rather than whether or not an individual has bought a fancy piece of equipment.  The imager is a helpful tool for the consultation but it does not in any way make up for the lack of qualification of poor surgical skills.

Gregory T. Lynam, MD · Answer

My opinion is that computer imaging can give a patient unrealistic expectations since a computer image can make you look great but the ability to do an operation to match the computer image may be impossible. I think too often it is used to sell a procedure to a parient. My book of before and after photos of the surgeries that I have performed is what I like to show people. I hope this helps. Please see a board certified plastic surgeon in your area for consultation.

Jay Calvert, MD, FACS · Answer

I have not found computer imaging to be accurate or predictive of what will happen during and after surgery. Computer imagers move around pixels - surgeons move complex tissues in three dimensions. There is not comparison. Some surgeons find computer imaging to be helpful in communicating with the patient the goals of surgery. This may be useful, but I use drawings. Computer imaging is not a measure of skill or confidence. Some use it ...some don't. Although patients are beginning to expect it so I may have to jump on the bandwagon and get an imager!

Barry L. Eppley, MD, DMD · Answer

Plastic surgeons have different approaches to how they plan and show different types of facial surgery. There are advantages and disadvantages to doing computer imaging from really helping to determine how much chin projection you want to showing results that can not be created surgically. The imaging is only as good as the person doing it. It can be both a good and bad plastic surgery tool. Computer imaging of chin augmentation is the simplest form of computer imaging and side projection views can be really helpful. I find it invaluable in my practice as a communication tool. But the quality of a plastic surgeon's work should not be judged as inferior just because they don't do computer imaging.

Kamran Jafri, MD · Answer

Computer / Digital Imaging utilization in the plastic surgery consultation process has become a much discussed and interesting topic. It can certainly be helpful in cases like rhinoplasty or chin augmentation where a specific structural change is being done on a part of anatomy that can be consistently predicted by your surgeon in a way that is fair and realistic for the patient to see.

	On the other hand, procedures like face lifts or double chin surgery have outcomes that can be affected by a patient's skin quality or extent of surgery done and the healing time that occurs over several months. In these cases it is not always as easy to predict what the final result will look like and therefore imaging is not as helpful and frankly in many cases can end up being misleading.

	Rely more on a surgeon's experience, training and honesty than on imaging.

Sheldon S. Kabaker, MD FACS (retired) · Answer

I have used some type of computer imaging (video, then digital) for over 25 years. Although most think it predicts the future outcome of surgery, I find it more useful for me to analyze the face. This helps me to propose certain procedures and to plan my surgical steps such as in rhinoplasty. Before the advent of this modality I used photgraphic prints of the patient to make drawings for the same purposes.

Richard W. Fleming, MD (retired) · Answer

Two friends who are artists with excellent computer skills can do a rhinoplasty with imaging as good or better than I, but I would not want them doing my surgery. We can demonstrate the proposed changes in your nose using computur imaging or drawing on your pictures. The best way to evaluate a surgeon and determine if you two have similar aesthetic tastes is to see pictures of results in multiple patients with noses like yours.

Ronald V. DeMars, MD (Retired) · Answer

Good for him. Computer images have absolutely nothing to do with what you will actually look like. As one of the consultants below indicated, you can make the computer image look like anything you want. Any good physician using a computer will make sure, in writing, that you understand the computer image in no way is a guarantee you will have that result. A bad doctor will use a computer image to sell you on a surgery. At least with no computer you can be sure the latter alternative will not occur.

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