Computer Imaging as a Reality Check « Secrets of a Beverly Hills Cosmetic Surgeon

Computer Imaged Photo

Example of Computer Imaging
Left: Patient “Before”. Middle : Computer predicted ” After”. Right: The actual “After”.

Readers of my blogs know that I am a big fan of computer imaging. Computer imaging, at consultation, demonstrates the predicted results of the procedure(s) on a computer screen.

What I have always liked about computer imaging is that it puts “on the table” what can and cannot be achieved. It is no longer a mystery as to what one will probably look like after surgery when you can see it on a computer screen. I have no problems showing the anticipated result, as long as I feel I am capable of delivering it.

Like most super-specialized and experienced cosmetic plastic surgeons, I would never portray a result that is beyond my capabilities, nor achievable by the surgical techniques of the day.

Recently, we had a very interesting re-consultation with a young woman concerning her nose. This encounter reminded me of the importance of computer imaging as a common ground for the best communication between doctor and patient. I immediately realized that this story would be valuable to you, my reader.

The young woman, 29-years old, had had two prior cosmetic nasal surgeries, rhinoplasties, in her native country as a teenager. Then she immigrated to the United States and, last year, had a third operation on her nose. She was unhappy with the first two operations and was still unhappy after the third. She consulted with me to ask if any further surgery could be done to improve her nose and match her concept of the “right nose”.

As is our office’s usual practice, I asked the young lady to provide me with photographs and medical records from the last treating surgeon’s office. She did that, and I was able to see the “before” pictures. That gave me an idea of what the last surgeon was able to accomplish. This is very important for the surgeon contemplating yet another operation because it may be that the changes that were achieved were all that one could reasonably expect to be accomplished.

I was impressed with the improvement that she received from that third operation. Frankly, it confirmed my impression that she had pretty much reached the limits of what surgery could accomplish for her.

Predictably, she was disappointed with my decision that further surgery was unwise.

While she was disappointed with my stance, what helped our patient understand the wisdom of my recommendation was a very detailed analysis of her current facial features on that computer screen. These very detailed photographic images showed her that, in fact, nature had created a rather wide distance between her eyes. Therefore, the nose, which must “fill” the distance, could not be significantly narrowed. It was anatomically impossible. I felt that her request, that the nose be further refined, was not achievable. Were another attempt be made without success, the patient would be very disappointed. Certainly, the surgeon would not be very gratified.

Without this detailed analysis of how her face was structured, which was only possible looking at the images on the computer screen, it may have been impossible for our lady to appreciate why I declined to operate.

Every surgeon needs to make the important decision: “Is it likely my surgery will be successful?” Even more importantly, “will it satisfy the patient?” In this case, I felt that I could not achieve the result the patient had fashioned in her mind. Only when I explained the anatomy that we saw on the screen, could the patient acknowledge that her construction ruled out another failed attempt to achieve the impossible.

The word “doctor” is derived from the Latin, docere, “to teach”; like “docent”, one who teaches at a museum.

We doctors should always be teachers. Not only of the generation of doctors who will follow us, but teachers to patients. Patients need to understand the complexity and challenges of what we do and that not always can we meet their conceptions and desires. Often, we need to remind them of our humility; that despite our desire to serve, the decision to serve is never knee-jerk. That “Go” or “No go” must be carefully thought out.

- Robert Kotler, MD, FACS

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