Simulated Nose Versus Real Nose?

Does a good surgeon have the ability to achieve exactly the same nose look as that chosen on a rhinoplasty computer simulator? How reliable is a rhinoplasty simulator for surgery guidance?

Doctor Answers 16

Computer Simulation of Rhinoplasty

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  • Imaging simulation is a very important and helpful tool. It provides another avenue for patients and surgeon to increase understanding and communication.
  • Even if the results differ from the simulation, the process of simulation on the screen helps the patient understand what changes may be possible, and it helps the surgeon understands what changes the patient really wants ( and its often difficult to fully describe theses changes without imaging). 
  • The simulation, along with thorough discussion, physical examination, and review of prior patient photos, all help the preoperative planning process so you can get the nose you want!

New York Plastic Surgeon
4.9 out of 5 stars 29 reviews

3D Rhinoplasty Imaging

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Pre-operative rhinoplasty imaging, especially 3D imaging, is a valuable tool for both the patient and the doctor. For the patient, imaging can help patients understand the effect that changing the nose has on the overall appearance. For the surgeon, imaging is an important part of the preoperative analysis and planning.

Patients and their surgeon should agree upon the goals for surgery, and imaging can help ensure that those goals and expectations are mutually understood. While imaging is useful technology, it is important to remember that it is just a simulation of a proposed result.

C. Spencer Cochran, MD
Dallas Facial Plastic Surgeon
4.7 out of 5 stars 149 reviews

Computer Imaging is helpful for the patient and the surgeon before performing Rhinoplasty Surgery.

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Computer-imaging is a routine part of nose job surgery consultations. It enables the patient to see what's attainable, and it also helps to assure the surgeon that the patient has realistic expectations. Computer imaging helps to set a realistic goal of what the surgeon thinks he may achieve, and to see if this would be a satisfying outcome for the patient. In my view, computer-imaging is an essential tool in the evaluation of my patients seeking cosmetic nasal surgery, and non-surgical rhinoplasty procedures.

In fact, I do the computer-imaging and I routinely take imaged photos to the OR and may refer to them during Rhinoplasty Surgery. In general, if my computer-imaging is found to be attractive by my patients, I will typically exceed their expectations. I'm surprised to see that many RealSelf experts do not find this tool useful for predicting outcomes and ensuring patients' expectations are realistic.

Hope this helps.

Dr. Joseph

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon
4.9 out of 5 stars 435 reviews

Imaging is a useful communication tool

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I think that the rhinoplasty computer imaging should be done by the surgeon who is going to perform the surgery.  It is a useful communication tool to convey preferences, between the surgeon and the patient.  The computer imaging does not guarantee the surgical result, but I think the surgeon should be conservative in depicting the post-operative result.  I published the following article in 2007...the abstract may be helpful, although the entire article is more detailed:
Plastic & Reconstructive Surgery:
1 April 2007 - Volume 119 - Issue 4 - pp 1343-1351
doi: 10.1097/01.prs.0000254825.41066.f2
Cosmetic: Original Articles
Realistic Expectations: To Morph or Not to Morph?
Agarwal, Anurag M.D.; Gracely, Edward Ph.D.; Silver, William E. M.D.
Background: The purpose of this study was to determine whether computer-morphed images convey realistic expectations of the postoperative cosmetic result to patients seeking rhinoplasty.
Methods: This was a retrospective study in which preoperative, computer-morphed, and 1-year postoperative images of 25 consecutive rhinoplasty patients were analyzed by 12 anonymous, skilled observers and by the operating surgeon in a double-blind fashion. Each patient's photographs were accompanied by an identical four-question survey. The survey assessed whether the morphed image represented an obtainable goal, the degree of similarity between the morphed image and the actual postoperative result, and the quality of the surgical outcome as compared with the computer image.
Results: As expected based on variations in individual surgeons' aesthetic opinions, the cumulative data from the 12 blinded raters across all patients indicated that 82 percent of the raters would have performed the imaging in either the same way or, at most, a slightly different way from the operating surgeon. Approximately half thought that the computer-morphed image did realistically predict the postoperative result but that it could be a bit closer. Seventy-five percent felt that the actual surgical result was either the same as or better than the predicted result.
Conclusions: Computer imaging for patients undergoing rhinoplasty does portray a realistic picture of the anticipated cosmetic result. However, because an average of 32 percent of respondents felt that the computer-morphed image did not predict the postoperative result, conservative imaging is encouraged to prevent false expectations.

Anurag Agarwal, MD
Naples Facial Plastic Surgeon

Computer Imaging and Rhinoplasty

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Studies have shown that there is about a 50% correlation between preoperative computer imaging and postoperative results (according to patients).  Therefore, although it can help explain what a Rhinoplasty procedure can do, the pictures you view may or may not be accurate.  I personally feel imaging conveys an implied result, despite disclaimers and advice to the contrary.  Based on this lack of accuracy, I do not use it in my practice.

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon
4.9 out of 5 stars 103 reviews

Teaching tool

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Computer simulation is an excellent tool to aid communication between a patient and a surgeon. It is certainly no guarantee of results! Surgery of the nose is an art and healing responses vary between patients. Most surgeons, and patients prefer their actual results to the computer simulations! Find an experienced surgeon who shares your goals and aesthetic and look at real before and after photos. The computer simulation is jus one part of a comprehensive consultation. Good luck! 

J. Charles Finn, MD
Raleigh-Durham Facial Plastic Surgeon
5.0 out of 5 stars 7 reviews

Simulated Nose Versus Real Nose

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The reliability of the simulation is as good as the software, and while the software has improved considerably over the years it still needs additional refinement before it can consistently provide reliable rhinoplasty simulation. Neither from the perspective of the surgeon nor the patient do you want to create false expectations from flawed software.

Kris M. Reddy, MD, FACS
West Palm Beach Plastic Surgeon
4.5 out of 5 stars 56 reviews

Rhinoplasty computer simulation

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I personally do not use computer simulation when consulting with a potential patient. I find it more helpful to show them before and after photos of cases that are similar to theirs.  Making a nose look good on a computer is easy. Actually achieving that same result is not.  Select your rhinoplasty surgeons based on the quality of their work on previous patients.  Make sure you see many examples and that you like the quality of work you see.

Ronald J. Edelson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 29 reviews

Computer imaging and actual surgery

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One of the reasons I do not use computer imaging is that it is almost impossible to achieve the same results as a computer because there are many variable that a compiter can not take into account for as what is seen and achieved in surgery.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Value of Computer Imaging

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Computer imaging is used as a tool for patient and surgeon to demonstrate the effects of changes in our appearance with surgical intervention. It is beneficial when discussing goals or desires, but is never a guarantee of results. When dealing with the human body no surgeon has that kind of control. Used in conjunction with pictures of similar previous patients, imaging will help individuals understand their surgeon's aesthetics and results.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 43 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.