Three-Dimensional Imaging in Rhinoplasty: A Comparison of the Simulated versus Actual Result

Overview

3D simulation is widely used to plan rhinoplasty, but whether the real result matches the preview had not been measured. Steinbacher's Yale group randomised preoperative, simulated and actual postoperative 3D images and had a blinded panel rate each (1 poor to 5 excellent) and pick the best of each series; nasolabial angle and tip projection were also compared.

Sections of note

• 40 patients.
• Preoperative images rated poor in 67.5% (mean 1.7); simulation mean 2.9 (good in 60%); actual result mean 3.4, good-to-excellent in 82.5% (P < 0.001).
• Panel preferred the actual result in 77.5% of cases versus the simulation in 22.5% (P < 0.001).
• Actual tip was more projected than simulated in both men and women.
• No difference in tip rotation between simulation and result. Level of Evidence IV.

What it means for a patient

• A simulation is a communication tool; in this study surgeons produced a result that observers liked better than the preview.
• Simulations tended to under-project the tip compared with what surgery delivered.
• The finding depends on surgeon skill and does not mean every surgeon beats their simulations.

Why this paper matters

It is one of the first morphometric comparisons of 3D simulation against outcome. Limits: 40 patients, single surgeon, physician raters rather than patients.

Terms

• VECTRA: a commercial 3D facial imaging and simulation system.
• Morphometric: based on measured shape.
• Nasolabial angle: the angle between upper lip and columella.
• Tip projection: how far the tip stands out from the face.