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3D Surface Imaging for Facial Plastic Surgery and Rhinoplasty

The 3D facial analysis attempts to measure the complexities of the human face and nose and takes into account the cephalometrics and skeletal structure as well as surface and the skin contribution to facial form. There are stereophotogrammetry, liquid crystal scanning, light luminance scanning and video systems.

Dr. Sam Rizk, a pioneer in facial plastic surgery and a board certified facial plastic surgery and rhinoplasty specialist, states that to achieve the best possible outcomes in facial cosmetic and reconstructive surgery, it is important to embrace the use of powerful 3D technological advances to more accurately assess patients and predict intraoperative outcomes. The foundation of these 3D tools are the patient’s unique anatomy and skeletal landmarks which makes the rhinoplasty or facial plastic surgery procedure more customized to the patient. Although morphing a 3D surface to generate a desired result is generally accepted in the animation and character modeling world, true surgical use requires that the software recognize various anatomical components, their relative positions to one another, and the biomechanical relationships within the craniofacial skeleton. Significant technological advances in the areas of computers, 3D imaging, and the internet in the last several years, in combination with the advances in intraoperative visualization using high definition telescope systems, have enabled a more accurate rhinoplasty and facial plastic surgery results. CT scans and MRI have significantly contributed to the advances in 3D imaging and the use of these scans intraoperatively to maximize patient safety and accuracy of results.

At the center of the 3D approach are digital patient or patient specific anatomic reconstruction (PSAR) images. The PSAR are not just 3D images (CT or MRI, or facial surface images), or traditional photographs/radiographs available in a file to view separately, it is an anatomically accurate data which superimpose to create a 3D reconstruction. This single dataset reconstruction from many separate data sets is called the image fusion.

When treating the face from a maxillofacial perspective, multiple imaging modalities are required to produce accurate PSAR model of the patient. Depending on the treatment, there is typically a protocol defined that requires a series of 3D images to be taken at specific points in time throughout the treatment cycle. The imaging modalities currently relevant to the maxillofacial region include traditional CT, or 3D facial surface imaging, or 3D dental model surface scanning. Most commonly, Dr. Sam Rizk, a NY rhinoplasty specialist and facial plastic surgeon, will use the primary modality which is a CT scan data fusion points.

The face is the foundation for communications and interactions with the world, and thus patients are concerned with the effect any surgery may have on their appearance. Dr. Sam Rizk states that facial plastic surgery is one of the most gratifying surgeries for both; patients and the surgeon since its impact on the patient’s lives is tremendous on building self-confidence but Dr. Rizk also warns that patients must have realistic expectations and must accept certain risks of surgery, which although rare, may affect final outcome. Although a series of photographs in 2D are traditionally used to document preoperative planning, the advent of 3D technology may improve patient-surgeon communication since how patients see themselves in photographs in 2D may be totally different than how a clinician sees the patient in the same photograph irrespective of the lack of 3D reality. There is less chance for error if the 3D image examined with the patient. With a highly accurate 3D surface image of the patient’s face, physician-patient communication is highly improved. It is important that patients also understand that a preoperative 3D morphing image may not translate into actual results postoperatively as the development of scar tissue and the skin thickness has an impact on actual results of rhinoplasty or facial plastic surgery.