Communication between patient and surgeon is critical to a successful rhinoplasty outcome, particularly when it comes to cosmetic goals. While most patients have a clear concept of the look they are seeking, accurately conveying that concept to the surgeon can be challenging. Since most patients prefer to decide their own cosmetic destiny, an accurate and effective communication tool is critical. Although some surgeons give only lip service to the customization of a nose and proceed to disregard the aesthetic preferences of the patient, others will faithfully execute the desired cosmetic changes as long as they are properly understood. In my opinion, honoring the patient’s cosmetic wishes (to the greatest extent possible) is one of the most important obligations of the cosmetic nasal surgeon. While I may not agree with the shape chosen, it is not my face and a happy patient is my ultimate goal. Although many patients have a firm cosmetic goal in mind, others are uncertain as to what changes would look best and may look to the surgeon for advice. Moreover, even those patients with strong cosmetic preferences may change their mind once they actually see the nose on their face. Consequently, a means of "previewing" the proposed cosmetic change is extremely helpful.
Prior to the advent of digital photography and computer imaging software, patients were forced to entrust their face to the surgeon with little or no concept of the intended goal. Fortunately, advances in computer technology, commonly known as computer imaging, now permit patients to evaluate various changes and choose the nasal contour that best suits their aesthetic tastes and preferences. The advent of computer imaging has greatly improved communication between patient and surgeon, and when used to its fullest potential, computer imaging can also improve the accuracy of cosmetic nasal surgery.
Computer imaging works by allowing the surgeon to selectively manipulate digital photographs in order to reshape the nasal contour without changing the surrounding face. When performed skillfully, the resulting morph is a realistic-looking image that enables both patient and surgeon to visualize the impact of specific cosmetic changes. Variations in nasal length, nasal width or nostril contour can be evaluated separately or in combination. The patient is encouraged to participate in the "design" of the new nose and to provide input regarding the desired shape. Because computer imaging allows for precise (virtual) enhancement of the nasal contour, an idealized simulation is created which can then be used to confirm and plan the appropriate surgical modifications. However, there’s a catch. Although the surgeon can produce a precise visual representation of the patient’s cosmetic wishes, in some cases the computer simulation may be wishful thinking. In fact, some overly ambitious computer morphs, while aesthetically desirable, may be technically unrealistic or even surgically impossible! Therefore, a reputable surgeon will avoid morphs that depict risky or surgically improbable changes. Although the potential for abuse is ever present, an honest surgeon will avoid overselling the operation with unrealistic or deceptive computer imaging. Moreover, even a realistic morph is difficult to replicate exactly in the operating room and no reputable surgeon will ever guarantee a specific surgical result. However, a final result that resembles the computer imaging is often accomplished in skillful hands, especially when the computer imaging is conducted in a thoughtful, reasoned and realistic manner.
In the final analysis, computer imaging is an enormously effective communication tool that allows the patient to visually confirm the changes they are considering, while it provides the surgeon with a concrete target to plan the operation. Personally, I cannot envision practicing cosmetic nasal surgery without the benefit of computer imaging technology, but computer imaging is only as trustworthy as the surgeon who creates it.