Virtual Rhinoplasty Becomes Reality: Intra-Operative Monitoring with 3D Photography

Purpose: Photography plays an important role in rhinoplasty for pre-operative planning, intra-operative decision making, and post-operative assessment. At present, plastic surgeons rely on two-dimensional photography that is limited as a true anatomic reference. Three-dimensional (3D) photography is becoming increasingly recognized as a superior method for viewing and analyzing the facial contour. The complex anatomy and subtle changes inherent to rhinoplasty benefit from the use of 3D photography and computer analysis.

Methods: Patients undergoing rhinoplasty had 3D photographs taken pre-operatively (n=16). A virtually rhinoplasty was simulated using 3D software during the pre-operative consult (Canfield Vectra H1). Intra-operatively, both the pre-operative 3D photograph and simulation were available for viewing. Intra-operative 3D photographs were then captured at baseline and at the following intervals: 1. Dorsal hump reduction, 2. Tip modification, 3.Correction of septal deviation. Interval 3D photographs were overlayed with the pre-operative 3D photograph and with the simulation, to visualize changes compared to baseline, and highlight regions requiring further modification. Immediate post-operative 3D photographs were captured prior to placement of the nasal splint. The patients and families were then offered the opportunity to view the post-operative result in 3D, as well as the post-operative 3D photograph overlayed with the pre-operative to demonstrate changes due to surgery.

Results: Pre-operatively, 3D photography and simulation aligned patient and surgeon goals and expectations before surgery. Intra-operatively, access to these images replaced the need for multiple 2D photographs for reference. Interval 3D photographs at key intra-operative steps overlayed with the 3D pre-operative image were most useful to guide dorsal hump reduction and tip rotation. Overlay between intra-operative photographs and the simulation highlighted adherence to the previously defined aesthetic goals. Post-operative 3D-photographs captured the result with minimal swelling. Post-operatively, all families wanted to see the 3D photos, none expressed any trepidation or aversion to the images. All reported that they found the experience positive, alleviating their concerns regarding the aesthetic outcome.

Conclusion: Intra-operative 3D imaging was most valuable for dorsal reduction and tip rotation. All patients/families to date reported that seeing the 3D simulated rhinoplasty results pre-operatively and immediately post-operatively on the day of surgery alleviated their anxiety. All report that they found the option to view the result and overlay beneficial, and would choose it again having been through the experience.