Can Computer imaging predict rhinoplasty results?

The usefulness of computer imaging to predict rhinoplasty is a frequent topic of conversation amongst plastic surgeons. There are essentially two camps of thought, the first being that it is generally a good thing and the second is that using this technology unrealistically raises expectations of patients and leads to disappointment.

California plastic surgeon Umang Mehta tested the accuracy of computer prediction in 38 patients who underwent rhinoplasty. The predictive images and actual photos taken six months after surgery were sent to two panels of judges, surgeons and non-surgeons, to assess how similar they were. On a scale of one to five, one being not accurate and five being very accurate, the surgeons gave the computer images an average score of three—moderately accurate. The non-surgeons were a little more impressed, giving an average score of 3.55.

These findings match my own experience. I have been using computer aided prediction for rhinoplasty for the last 8 years and my impression is that people’s noses end up looking quite like the computer prediction (i.e. it is moderately accurate).

“So why use computer prediction if it isn’t that accurate?” the sceptics would say. I think this misses the point. Many people who come for a rhinoplasty consultation are fairly sure they want to change the shape of their nose and have a rough idea about the change they want. Their wishes are often difficult to describe in words and so many people bring pictures of noses they like or refer to pictures of relatives with noses they consider better than theirs. These aids to discussion in the consultation are helpful, but don’t get around the fact that a nose that looks good on someone else’s face may look good on yours.

In my practice, the great value of computer prediction is that it allows the surgeon to establish the shape of a nose that fits harmoniously with the general shape of the face. There are often many possibilities and which to choose is a matter of personal choice. I think the real value of computer prediction is that it gives the surgeon and patient the chance to discuss visual representations of the possibilities and decide together on the desired outcome. Ultimately, computer prediction results in an outcome that is much closer to the patient’s wishes.