Digital Imaging in Secondary Rhinoplasty

Overview

Computer imaging is widely used to show patients what a first-time rhinoplasty might achieve, but little was known about its role in secondary surgery, which is more complex. The authors reviewed 40 consecutive secondary rhinoplasty patients operated by one surgeon between January 2000 and August 2013, grading how closely the result matched both the preoperative photographs and the simulation.

Sections of note

• Retrospective review, 40 consecutive patients meeting inclusion criteria, 35 women (87.5 percent) and five men (12.5 percent).
• Degree of improvement was graded against both preoperative photographs and the software simulation, using a graded scale.
• Two observers scored each region. Average ratings: nasal dorsum 2.36, midvault 2.65, nasal tip 2.27, nasal alae 2.63, nasal base 2.99.
• The nasal base scored highest and the nasal tip lowest.
• The authors conclude digital imaging gives a reasonable expectation for secondary rhinoplasty patients.
• They add that it must be used cautiously, because these patients have heightened expectations and anatomy altered unpredictably by earlier surgery. Level of evidence 4, therapeutic.

What it means for a patient

• Simulations are a communication tool rather than a promise, and this study puts numbers on how closely they were matched.
• The tip and the bridge, the two features patients most often focus on, were the hardest to predict, and the authors say this should be discussed before surgery.
• In a revision case the surgeon cannot know exactly what remains inside the nose until it is opened, which is why prediction is harder.
• Single surgeon, retrospective, no patient-reported satisfaction, and the abstract does not state what the grading scale ran from or to.

Why this paper matters

Showing a patient a simulated result shapes their expectations, and revision patients are described as already having heightened ones. Quantifying which regions the simulation predicts well is directly useful in consultation. Whether showing the image improves or worsens eventual satisfaction is not tested.

Terms

• Secondary rhinoplasty: an operation on a nose that has been operated on before.
• Digital imaging or morphing: digitally altering a photograph to show an intended result.
• Nasal dorsum: the bridge of the nose.
• Midvault: the middle third of the nose, between the bones and the tip.
• Nasal alae: the outer wings of the nostrils.
• Nasal base: the bottom of the nose where it meets the lip.