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| By

Tatyana Khan, MD

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Photos are a part of every consultation with a plastic surgeon. Their purpose is several-fold. These images capture the features as they are and allow the patient and surgeon to have the same perspective on the area of concern. This allows the patient to communicate with their surgeon more effectively, using the same references and language. It can even inform patient’s expectations for what the final result may look like through the use of “Imaging,” a technique that makes defined changes to the patient’s preoperative photographs to adjust features in a way that emulates the desired changes. 

This technique is very different from the photo filters available on social media platforms which use a “standard stamp” principle to overlay a “generically attractive” set of characteristics over faces regardless of whether a particular person’s natural features can be modified in that way and erasing much of the individual identity of the subject.

In contrast, Imaging photos are intentionally made to appear realistic, like a photograph of the patient’s near-future self, to help the patient focus on how the planned changes affect their overall appearance, rather than viewing the changed feature in isolation.

The adjustments made using Imaging are defined and curated by the plastic surgeon whose training and experience inform their understanding of the kinds of changes that can and cannot be achieved with a specific procedure. Thus, Imaging photos reflect the realistic limits of changes that a human face can undergo with the planned interventions.

In some cases, these changes can certainly be dramatic, particularly if the goal is to show the final appearance of a chin augmented with a silicone implant, for example. If the same patient is also undergoing rhinoplasty to refine the appearance of their nose, the modeled image can demonstrate how transformative these coupled changes can be.

As realistic as these images can look, it is important to understand that they are never going to reflect the full reality of the competing and gradual healing forces that take place after the procedure and contribute to the patient’s eventual appearance. Additionally, the Imaging technique does not attempt to depict the reality of the structures beneath our skin that create the outward appearance. Looking at the imaging, it may appear that decreasing the slope of the nose is as simple as “trimming excess tissue that props the skin up.” This is partially true as often the top side of the nose is “dragged forward” by septal cartilage that’s grown beyond the proportions of the other structures that make up the middle part of the face. But on either side of the septum, there is a pair of “leaf thin” cartilages that are tented up by the septum to create the gentle slopes from the top of the nose to each cheek. Similarly, at the tip of the nose, the septum supports two strip-like cartilages which drape out to each side to create the nasal openings. Adjustment of the septum would require adjustment of these sets of cartilages which have their own intrinsic qualities and limitations in maintaining the desired shape. Due to the three-dimensional complexity of these underlying structures, the goal of surgery is to recreate the crucial changes modeled in Imaging as closely as possible, rather than expecting the two to look completely identical.

Imaging can be used to model changes due to a number of commonly performed cosmetic procedures including rhinoplasty, brow lift, cheek and chin implants, and facelifts. This allows the patient and the surgeon a common tool to communicate about how each one achieves specific treatment goals. Ultimately, while Imaging is a valuable tool, especially for visualizing the changes resulting from certain procedures such as rhinoplasty, it facilitates an effective doctor and patient relationship but does not replace it.  More than all the modern technological resources, a positive patient experience depends most heavily on working with a facial plastic surgeon who is confident in their skills and clear in their communication regarding surgical goals and post-operative recovery and surrounded by knowledgeable, attentive staff. When you are ready for your journey to start, find your team, and the rest will fall into place. 

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