Computer Planning and Simulation Techniques in Rhinoplasty
10 April 2020 onur
– Doc, will I be able to see the shape of my new nose before the operation?
We can only see the new shape of your nose after rhinoplasty.
Moreover, the noses you will see in the first week, first month, third month, first year, third year and tenth year after surgery will be different from each other.
No surgeon has the ability to fully predict situations that may arise during or after surgery. Perioperatively or postoperatively, the process may not go exactly as planned for many reasons. Even if you are the most experienced and talented nasal surgeon in the world, it is not possible for you to completely control processes such as cartilage resorption, bending deformity (intrinsic warping), soft tissue atrophy, infection and trauma that may occur postoperatively.
Maybe I have painted a pessimistic picture so far, but the ratio of conditions and processes that we cannot control in open structural ultrasonic rhinoplasty approach to total cases is roughly around 5-7%.
In rhinoplasty, it is necessary to distinguish between the following two concepts: Planning and Simulation.
- Planning refers to the surgical technique design that your doctor makes before the surgery.
- Simulation, on the other hand, is a preview of the nose shape likely to emerge as a result of that plan.
Highly successful results can be obtained or patients may be perfectly satisfied without any planning and simulation as well. Surgeons who are confident in their experience and talent can plan the operation on the spot while the patient is on the table or in their head without the need to write and record. Therefore, pre-operative planning or simulation is not an absolute requirement. Due to the working conditions of some of my colleagues, they may not have time to devote 20-30 minutes to a planning/simulation session amid their busy work schedule.
However, what is “ideal” both academically and clinically is to make and record the planning before surgery. Planning is academically invaluable. It contains information about how you reached the targeted result or how you did not reach it if you did not. In the long run, it reduces the likelihood of repeating mistakes for a surgeon.
In pre-operative planning, we first examine the nose, particularly the external structure of the nose and the airway. We determine the aesthetic and functional results of the nose in addition to special conditions and limiting factors for surgery. Then we listen to the patient’s wishes and desires. After this information gathering phase, we decide whether the patient’s desired result is aesthetically and functionally possible. Surgery is planned by the surgeon, taking into account the patient’s wishes.
As a next step, a simulation is created on the computer, and the surgical planning is visualized.
Simulation is a communication tool for you to have an idea about what your surgeon is planning before the surgery.
The golden rule in all simulations is that the simulation itself is not a commitment. For various reasons, you may not get the same result as in the simulation. But at least you have an idea of what the surgeon is planning before the operation. For instance, if I were a patient, I would like to see what my doctor has planned. Because if I don’t like the planning, the fact that the surgery would be performed with a plan I didn’t like would definitely bother me. What if the doctor planned a nose that I wouldn’t like and he was successful in his plan?
In my practice, planning and simulation is routinely done following the initial examination. While I am planning and simulating, my patient can monitor and follow the process live on the screen. After the measurements, planning and simulation are finished and an image appears on the computer screen, I review this plan with my patient.
Most of the time, my patients like my planning. Sometimes, it may not be exactly how my patient desires. In that case, I clearly explain why planning should be done that way, citing and describing aesthetic and functional reasons. In cases where my plan and the patient’s expectations do not match, the patient has the option to part ways with me and continue with another doctor. As a rule, lack of communication preoperatively results in post-operative dissatisfaction for both parties.
Most of us are so accustomed to having “control” in every aspect of our lives that it is difficult to give up control over how a structure in the center of our face will be shaped. It would be difficult for me if I were a patient. But surgery is like that. At some point, you have to trust and let go of the strings.
During planning, I tell each of my patients the following:
The result of your surgery will never be exactly the same as here, but it will most likely be pretty close to the planning here. If your surgical outcome is significantly different from the planning here, a revision surgery may be needed to get us closer to the planned outcome.
In the open structural ultrasonic rhinoplasty technique I use, postoperative structural changes are more limited compared to dynamic rhinoplasty approaches since the nose is built on a static cartilage structure in my technique. This fixed building philosophy allows for static planning as in a construction project as well as the implementation of that planning. I strongly recommend you take a look at my post on my surgery technique and philosophy.
You can contact us for more detailed information about the planning process and simulation options before rhinoplasty.
Take good care…
… of yourself and your beauty.