October 23, 1998

New technology previews plastic surgery results

New technology previews plastic surgery results

The question, "What will I look like after plastic surgery?" is being answered with a greater degree of accuracy at Vanderbilt University Medical Center.

A new computer imaging system is giving doctors in the Department of Otolaryngology the ability to show their patients beforehand what proposed facial plastic surgery changes will ultimately look like.

"This is such a powerful tool and is so very valuable to the patient and to me," said Dr. W. Russell Ries, associate professor of Otolaryngology. "I show patients what desired changes on their faces will look like. It¹s not a guarantee, but it¹s a very realistic approach. No matter what, it must be something that I can achieve in the operating room.

"And it¹s very beneficial, I think, to show changes on their own faces. We can always show pictures other patients who have undergone similar procedures, but it¹s so much more beneficial to show them the changes on their own face."

Ries uses the computer imaging system to preview rhinoplasty, blephroplasty, face-lifts, chin implants, cheek implants, and even scar revision.

Sitting at a computer keyboard, Ries can measure angles for the tilt of the end of a nose, can enlarge cheekbones, minimize fat on the chin, or can even tighten skin around the eyes, all with the flick of a mouse button and a touch of the keyboard.

He can even 'morph' the computer image, going from the "before" picture to the doctored "after" image.

The computer-imaging system can also demonstrate laser resurfacing by manually blending away the fine lines and wrinkles on the patient¹s computer image.

"It¹s not a dramatic change, it is not supposed to be. It will give me a good representation of what can be done with CO2 laser resurfacing," Ries said.

There are also special modules on the computer system for teaching about specific surgical procedures and for preparing presentations to fellow physicians.

Ries and two staff nurses have been trained on the new computer imaging system. He says they are very careful to advise patients that the image is simply a simulation. A disclaimer on the screen serves as a further reminder.

He says they work carefully to make sure they present a realistic image on the computer.

"I would much rather show something that is maybe just a little bit less than the optimum that I could achieve surgically so that there is no misinformation given to the patient."

Ries says sometimes patients even decide against surgery after seeing the computer image.

"I will make changes that I think are reasonable and feasible to accomplish, and a patient will say, ŒNo, no, no. I want it more narrow.¹ If I don¹t think I can do that or I doubt the desired outcome can be achieved, then I have to tell them that. That is a good thing for both patient and doctor to understand before surgery.

"The more informed someone is prior to going into surgery the better he or she does."

Patient Penny Welch is preparing for a nose job. After years of having trouble breathing, she is ready for Ries to clear up her problems and at the same time give her a better-looking nose. Ries also plans to do some liposuction on her chin.

Several weeks before surgery, Welch and Ries conferred at the computer keyboard as Ries made changes on a picture of Welch¹s face on the computer screen.

"She wants her nose more defined. There is not enough rotation and we need to reduce the hump on it. I will set the tip of her nose in a new position. These changes will improve the look of the nose and give her better function."

Welch likes the computer imaging approach.

"It¹s great because it leaves the imagination out of it," Welch says. "You get a better idea about what to expect.

"Plus, it gives you encouragement because after surgery you are kind of swollen and I think you are pretty shocked, at first. This gives you a good idea of what it is going to be like after you have recuperated from surgery."

This is the third computer imaging system Ries has used in his practice in the past ten years. He says this latest system has very advanced capabilities and is more "user-friendly" than previous systems.

It fills an important place in his medical practice, he says.

"I think the thing to know is that this is a tool and it¹s not an absolute certainty about surgery. But, again, it¹s always better to see changes on your face than someone else¹s."