DO YOU WONDER HOW YOU WILL LOOK AFTER A PLASTIC SURGERY PROCEDURE? THE ANSWER TO SATISFY YOUR CURIOSITY IS HIDDEN IN THE TECHNIQUE OF 3-DIMENSIONAL IMAGING IN FACIAL PLASTIC SURGERY.
The 3-dimensional (3D) imaging technique, which has provided plastic surgeons with great convenience, also ensures for patients who will undergo procedures to gain insight about the results. Professor Halil İbrahim Canter, an aesthetic, plastic and reconstructive surgeon at Acıbadem Bakırköy Hospital, shared with us the details on 3D face imaging, the technique that has many advantages when it comes to achieving what is desired the most.
What kind of a technology is 3D imaging?
Human faces have very complex anatomies. When the surgical procedure is planned on the basis of the insight acquired from the evaluation of a single photograph or a physical examination, there is always a margin of error. Furthermore, it is essential for us to enable trauma patients to recover their former state as much as possible, as well as keeping track of the changes that occur during the procedures on patients treated purely for cosmetic reasons and replanning the procedure in accordance with the progress of the operation and the patient. Therefore, initial documentation is vitally important. By means of advanced technologies, we can now acquire images via blending the soft tissue and bone contour images provided by 3D Computed Tomography devices with the images provided by 3D cameras. We use these images in both planning and performing procedures.
WHEN DID THE USE OF THIS TECHNOLOGY START?
3D CT technology has been in existence for many years but its capabilities have changed continuously. I started using a system with this technology in 2005. In those times, I was using the seventh version of the system; now, we have the sixteenth version. The capabilities of the technology are based on solid, scientific evidence and these keep adding to the power of the technology. Therefore, our trust in 3D CT increases with each passing day.
What kind of advantages does the technology have?
3D imaging in facial plastic surgery is not used merely for patient documentation purposes. Currently, it is also possible to plan surgeries in an improved way through use of the said digital 3D images and different program interfaces. Recent developments have also brought 3D printers with them. The 3D titanium printers in the market make is possible for us to create solid models of patient tissues and try the incisions to be performed during surgery on these models. The printers also make it possible for surgeons to produce patient-specific 3D fixation plates and 3D cutting molds, which are used for keeping the bones of patients in place during surgery and simulating the bone cuts to be performed on the patient before the surgery. Bone implants that are intended to provide surface contour with cosmetic purposes can also be planned and produced beforehand. In other words, these technologies ensure for nothing to be left to chance. This way, surgeons make use of exact mathematical measurements during preoperative planning and perform surgeries as precisely as planned.
“Since 3D imaging systems ensure for procedures that are considered to be “impossible” or “ineffective” to be carried out wonderfully, they play a major role in cosmetic and reconstructive operations. These systems are now among the irreplaceable elements in facial surgery.”
What is the course of the process before an operation which is to be performed with 3D imaging?
The first thing to be determined is whether the procedure will involve both soft tissues and bone structures. If it is limited to soft tissues, the usefulness of CT vanishes because its use exposes the patient to radiation for no good reason. It is possible to use 3D CT for medical purposes but the same surface images can also be acquired by use of 3D cameras. Once acquired, such images can be used for rhinoplasty or measurement of certain aesthetic surgery points and calculation of volume. On the other hand, CT scans are essential for procedures that involve bone structures.
Which areas is the technology used on the most?
It is used frequently for lower and upper jaw reconstruction and eyelid operations. The technology is also used for documentation of reconstructive surgery measurements in patients with cleft lips and palates and patients who have problems such as missing or prominent ears. Another area in which the technology is beneficial is cosmetic surgery for those who wish to enhance their noses and faces with filler materials.
Do you also consult the patient who will undergo surgery?
While I share the photographs we acquire with the patients themselves, I still have some reservations about showing them simulation results. When you show patients the electronic simulations on the computer, this is perceived as a pledge as to the results to be acquired and it is thought that you simply have to do it. However, due to the surgical complications that may arise during the procedure, I don’t consider going to surgery with such promises to be the right thing to do as a surgeon, especially when complicated operations are involved. On the other hand, I make great use of the images in question while planning the operation and inform the patients that their images will be used for these purposes. If they wish, I also provide them with images produced after the operation. There are times at which I prefer not to share the intermediate stages of plans. At other times, I show patients, particularly those up for reconstructive surgery, some simulations in order to help them understand what will happen during the intermediate stages. This provides patients with better insight into the procedure, as well as information regarding the postoperative recovery period.
In plastic surgery, motivating the patient before undergoing the operation affects the success rate of the procedure to a great extent.
What are the technical differences of 3D imaging when compared to CT?
In daily life, you need both of your eyes to perceive depth. In similar fashion to this, you cannot achieve three dimensional images unless you use two lenses at the same time. Images acquired via a single lens are bound to be two dimensional. Precision can only be increased by increasing the number of lenses. The three dimensional photography system we use produces images from different angles with a total of six cameras at the same time. The software of the computer, which operates in the background, combines all images and turns them into three dimensional surfaces. CT, on the other hand, is a little different. X rays provide cross-sectional images as they pass through. When all these images are stacked on top of each other, they produce a bulk, just like a deck of cards. CT works in a similar fashion. However, in CT, the bulk image that is acquired turns into digital data which can be used everywhere. You can use this data for 3D photography images to overlap 3D CT images or gain insight as to how a change you will make in one will affect the other.