Three-Dimensional Imaging in Rhinoplasty

The Problem

Currently, most surgeons performing rhinoplasty procedures utilize two-dimensional (2D) photography to evaluate new patients, to document results, and to plan a successful procedure. It is important to note that 2D photography lacks the ability to document the entire clinical picture. In today’s cosmetic medicine market it is more important than ever before to document results from various procedures such as rhinoplasty.

Being able to illustrate a complete clinical condition with 360-degree dynamic imaging and/or three-dimensional (3D) capture enables surgeons to communicate with patients more clearly and to also develop a surgical plan that will be successful. Evaluation of results is also much more comprehensive with a complete clinical picture of outcomes obtained with rhinoplasty. For a surgeon, the ability to go back and review a complete lifelike before image of the face and nose compared to the results provides such important lessons of learning. With today’s savvy consumers, it is more important than ever to be able to provide patients with state-of-the-art imaging that is better than the pictures that one can capture on any smartphone. Being able to sit down with each patient and review a high-quality 3D digital capture is an essential tool for today’s successful rhinoplasty surgeon. New technology that results in 360-degree motion capture with the oVio360 Dynamic Imaging System is also being introduced to the market. This new system allows perfectly standardized images to be captured before and after all procedures. Using the unique self-centering technology, images are easily obtained and always perfectly positioned and lighted for standardization. Regarding the face and nose, the workflow and capture of oVio360 images include five views. The views include (1) Repose; (2) Smile/animation; (3) Chin up; (4) Chin down; and (5) Relaxation and flexion of the neck muscles ( Table 5.1 ). Each 360-degree view capture takes 12 seconds and the resultant digital file provides a complete picture of the shape and form of the head and neck as well as nerve and muscle function. Being able to capture the face and body in motion provides the most life-like capture of the face and body. Dynamic imaging allows the understanding of skin quality, muscle, and nerve function. Visualizing the nose and face in animation allows patients to see themselves exactly as others view them. With this process, the provider and the patient have a comprehensive lifelike digital medical record that will capture all perspectives of each therapeutic intervention. With today’s advanced technology that addresses all aspects of the skin and underlying soft tissue, motion capture is the only imaging technology that captures the complete clinical picture.

Table 5.1

oVio360 Dynamic Imaging Workflow–Face/Nose.

Workflow Image Capture 360-Degree Revolution
1.Repose: Physical shape and form of the nose and the entire surrounding facial and neck anatomy
2.Smile/Animation: Nasal movement with animation, i.e., plunging tip, flaring nostrils, etc., nerve and muscle functionality, skin turgor, dynamic rhytids
3.Chin Up: Worm’s eye view of nose, nostril shape, symmetry, etc.
4.Chin Down: Nasal dorsum, bony pyramid
5.Neck Muscle Flexion and Relaxation: lip complex movement and symmetry, evaluation of motor nerve and muscle functionality of remainder of head and neck

The differences between 2D imaging and 3D capture are significant. Standard photographs only provide a limited view of the anatomy. Being able to determine the depth and shape of the face and nose is limited and the ability to rotate and view the nose is not possible. With 3D surface imaging, the subject can be viewed in all perspectives and a true lifelike image with skin texture and x, y, and z coordinates is created. In cases of significant deformity such as trauma or congenital defects, a magnetic resonance imaging/computerized axial tomography (MRI/CAT) scan can be utilized to document the internal structures of the nose, sinuses, and facial bones, etc. Software has been developed to combine the results of the 3D surface imaging with the MRI/CAT scan to provide a complete 3D model of the surface and underlying subcutaneous and bony anatomy. This type of combined imaging is utilized in complex rhinoplasty/facial procedures that involve deformities that may be congenital (cleft deformities) and/or posttraumatic or procedures involving deeper structures including cartilage, bone, and mucosal soft tissue.

The Background

Three-dimensional surface imaging has found its place in plastic and reconstructive surgery globally. The first attempt to use 3D surface imaging technique in clinic was in 1944 by Thalmaan, who used stereophotogrammetry to examine an adult with facial asymmetry and a baby with Pierre Robin syndrome.

Early studies involving 3D surface imaging systems were mainly completed by using stereophotogrammetry. Although the results were not precise enough and hard to be quantitative, it still showed that the 3D surface imaging system did have great potential and apparent superiority compared with 2D photography. Other techniques such as Moiré topography, laser scanning, structured light, and so on, have been developed and studied. As a result of the various studies of 3D imaging it is apparent that the technology is best utilized to determine objective changes in volume such as in breast surgery and fat injections. The static 3D image capture provides accurate objective true surface dimensions, morphologic changes, and volumetric changes when comparing before and after results. Another valuable use of the 3D technology is to be able to show prospective patients how they may look with various procedures and also to allow breast implant patients the ability to participate in the selection of breast implant sizes. In patients who desire a change in the appearance of the nose, the surgeon can use software-morphing tools to change the shape and contours of the nose, thus allowing each patient to understand the realistic goals of a rhinoplasty.

Using oVio360 dynamic imaging in nasal surgery allows the patient and surgeon to observe and document movement of the nasal tip with animation. Thus, when comparing the before and after dynamic images, the surgeon will be able to document correction of issues such as a plunging tip. Regardless of whether a static or dynamic image is captured, it is important to have a comprehensive digital record of the morphologic features of the nose so that operative planning can be completed, and the ultimate result can be recorded and reviewed with each patient. The oVio360 images are used in all steps of the patient experience, including the initial consultation, preoperative visit, intraoperative guidance, and postoperative follow-up, and for presentation and publication. Being able to show actual before and after images gives each prospective patient the opportunity to understand the surgeon’s results and aesthetic ideal.

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