Photography in Rhinoplasty 2024 .pptx

photography is important aspect in rhinoplasty.

1. 1 Dr. Manya Thakur Roy Associate Professor JNMC Raipur Director Maya Aesthetic Clinic MS ENT & HNS,Gold Medalist Fellow Rhinoplasty & Facial Plastic Surgery (ISFPRS) Fellow in Facial Plastic Surgery & International Visiting Scholar from at Asan Medical Centre Seoul, South Korea. Fellow in Facial Aesthetics from Aesthetics Clinic Noida Delhi Photography In Rhinoplasty

2. Analysis of the Nose 2

3. Why ? Consultation with patients Pre Operative Planning Reference during operation Assessment of results Documentation for Medico legal purpose 3

4. Patient Preparation L east distraction and most consistency between pre and postoperative photos.  Hair Style, Make-up And Clothing( standard hospital gown) Background is typically medium blue, complimentary to all skin tones, reduces glare, and provides good contrast. The material of the background should be nonreflective material with a matte finish, wrinkle free. 4

5. 5 RHINOPLASTY QUESTIONNAIRE Have you ever injured your nose? Have you ever fractured your nose? When?____________________________ □Yes □No □Yes □No □Maybe How?______________________________ Did you seek medical treatment for the nasal fracture? □Yes □No Did you have x-rays of the nasal fracture? □Yes □No Do you have difficulty breathing through your nose? □Yes □No When? Only at night? □Yes □No While eating? □Yes □No Other________________________ Have you experienced any of the following: During exercise? □Yes □No □Nasal infections □Nasal pain □Sinus infection □Sinus pain                                                                 □Headaches □Nose bleeds □Snoring □Nasal allergy □Runny nose □Sore throat Have you ever seen a doctor for any of the above-listed problems? □Yes □No Who______________________________________________ When_____________                            Findings_________________________ Treatment___________________________________________                                                                                Do you take any medication to improve your nasal breathing? Which ones?__________________________________________ How often?___________________________________________ Have you ever had nasal surgery? When?_____________________________________________________ By whom?__________________________________________________ Results_____________________________________________________ □Yes □No □Yes □No                                                                        Any problems or complications? □Yes □No Do you wish to change the appearance of your nose? □Yes □No How long have you considered changing the appearance of your nose? What parts of your nose bother you? □Base □Bridge □Fracture Deformity □ HeightLength □Profile □Septum □Skin □Tip □Width □Other________________________________________________________ Are you interested in discussing a chin implant or liposuction on your neck? □Yes □No Insurance: Some nasal surgery is covered in part or in full by health insurance policies. Most cover functional reconstructive improvements, but do not cover cosmetic surgery. The insurance companies require a written report from our office before making a determination of benefits. This report will contain information you have provided on this form and the results of your examination. Polaroid photographs will also be taken and sent to your insurance company. It is entirely your choice if you would like us to prepare such a written report along with your photographs for pre-determination by your insurance company. Your insurance company will be billed for the report and the functional portion of your examination. Do you wish this office to prepare an insurance determination report for payment of your nasal surgery? □Yes □No Do we have your permission to send photographs of your nose to the insurance company? □Yes □No                                                                                                                                                  Signature Date

6. Basic Knowledge Photography Skills Photographic studio space Lighting and flash system Background Camera and lenses Recording media Standard positioning of patient head Appropriate Photographic views Analysis of photographs Formulate surgical plan 6

7. Photographic set-up Space Background Arrangement 6 by 8 feet Neutral colour such as soft white External light from window should be blocked Light blue tone is ideal Camera to patient distance ideally should be 4 to 6 ft Lightening system consists two electronic light sources Dual electronic flash positioned 3 to 5 feet from patient and 45 from camera 7

8. 8 1m *2m

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10. 10 12-megapixel DSLR camera (4200 by 2800 pixels image producing an 8 by 12 image) is ideal for visual inspection of the edges of the pictures and improved zooming in while retaining definition. R ing flash /soft box/umbrella The ideal light temperature would be near the higher ranges, 5000 to 5500 Kelvin, to keep the photograph as accurate as possible with minimal distortion.

11. Photography in aesthetic plastic surgery relies on digital single-lens reflex cameras (DSLRs) or, more recently, mirrorless cameras. Resolution of 5 megapixels or higher is the bare minimum for publication (2500 by 1800 pixels producing a 6- by 9-inch image), a value surpassed easily by current cameras As reference, current smartphones have resolutions from 8 to 12 megapixels and beyond 11

12. Camera and Lenses Ideally digital single lens reflex (DSLR) cameras should be used Advantage of DSLR cameras DSLR use interchangeable lenses and have larger pixels Use top mounted flashes Photographs can use manual controls and fixed focal length lenses Portrait lenses recommended for Rhinoplasty They have focal length 90-105 nm and prevent barrel distortion that occur due to shorter focal lenses 12

13. Head Position All jewellery and makeup should be removed. Patient should be relaxed with no facial expressions except in smiling view Gaze in direction of fixed object Frankfort horizontal plane for standardize head position Position of ear lobe with respect base at nose should be noted. 13

14. 14 Cephalic Tragus – lower orbital margin

15. Nasal Anatomy and Facial Analysis Systematic Preoperative Analysis Upper Third Middle Third Lower Third Techniques Upper Third Middle Third Lower Third 15

16. Goals of Photo documentation Photograph should be Uniform Colour before and after surgery Define & Document Patient Deformity And Aesthetic Goals For Communication Between Patient And Surgeon Regarding Treatment Plan And Expected Out Come. Medicolegal Purposes Marketing And Educational Purposes . 16

17. Full Face View Relationship of the nose to other facial features 17

18. Photographic Anatomy Most Include following details about Nasal Dorsum Deviations, width and nasal bone height 18

19. The Nasal Tip Tip shape, Tip defining points ala-columella relationship 19

20. The Profile Radix, dorsal height irregularities nasal length & projection 20

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22. The Nasal Base Nostril size and symmetry, alar width and scars 22

23. Standard Views for Rhinoplasty Photography 23 Six Standard view necessary to evaluate nasal anatomy:- Frontal Lateral (Right & Left) Oblique (Right & Left) Basal View

24. Standard Views for Rhinoplasty Photography For additional analysis : - Dynamic View-to assess dynamics of nasal tips & alar base during smile Cephalic view to assess existing deviations. 24

25. Frontal View Patient should look straight into the lens. Head is in natural horizontal facial plane with the camera at eye level Anatomically framed using Superior Border-Top of the hairline Inferior Border - Thyroid cartilage prominence. 25

26. Assessment in Frontal View Dorsal aesthetic line Straight, symmetrical or asymmetrical well or ill defined Bony vault Wide/narrow short/long nasal bone Bony base should be 75-80% of width of alar base Ala base width should be approximate the inter canthal distance 26

27. 27 Mid vault Narrow or wide collapsed inverted v deformity

28. 28 Nasal tips Tip should have 4 defining landmarks the supratip and infratip breaks and the domes of the lower lateral cartilages supra tip, tip defining points infra tip lobule broad, bulbous, boxy Alar rims Columella ala relationship Gull wing appearance, notching, retraction

29. IIIusions in Rhinoplasty Saddle deformity either bony or cartilaginous give appearance of over wide dorsum Low Dorsum – gives appearance of increased nasal width due to less shadow along nasal wall 29

30. Deep Nasofrontal angle gives appearance of short nose Hump of dorsal convexity – Narrowness of Nose IIIusion of Decreased projection 30

31. Profile View Patient looking straight ahead and oblique The head positioned in the natural horizontal facial plane 31

32. Assessment in Profile View Radix High or low radix Depth of Radix is usually 9.14 mm Nasal Dorsum smooth, hump, scooped out should be at 1.2 mm posterior to line from nasion on to nasal tip Nasal length & Height Long or short Length from radix to tip Alar Columella relationship Retraction or hanging of columella and alae 2-4 mm Columella should be visible Supra tip break fullness, polybeak Tip Projection and rotation 32

33. Tip Projection & Rotation BOXY ,BIFID,BULBOUS AMORPHOUS Tip Projection Distance from vertical facial plane Passing through ala crease to nasal tip Ideally tip projections in 2/3 of ideal Dorsal length 33

34. 34 Tip Rotation Tip rotation is defined as the tip angle which is measured from vertical plane at ala crease to tip. Degree of tip rotation based on degree of nasolabial angle TA / TN = .55-60 R L Goode N T A

35. NFA is most important aesthetic angle in the entire face. Blunted Naso frontal angle is due to bony prominence or thick procerus muscle. Shallow NFA angle - result longer nose. Acute NFA angle - gives the short nose appearance. 35

36. Patient is turned to line up the tip of nose with lateral cheekAssess asymmetries of the dorsum and supra tip area. Oblique View 36

37. Basal View The head is tilted back, and head and chin make up the anatomic frame Superiorly and inferiorly, respectively In full basal view, nasal tip is lined up with median canthus 37

38. 38 BASE VIEW Isosceles triangle, gently rounded apex Asymmetry of tip Divergence of intermediate crurae Domal angle Caudal septal deviations

39. Assessment in Basal View Nostril Size, shape, symmetry and orientation Columella width and length of columella septal tilt and flaring of medical crura Width of Alae Base & Nostril Sill it determine amount of alar flaring Width of Alar base = intercanthal distance Soft triangle and nasal projection 39

40. Smiling Frontal and Lateral View (Dynamic View) 40 These views highlight changes and help to identify an overactive depressor septi nasi muscle Can cause excessive tip and ala base movement, resulting in a displeasing appearance

41. Smiling Frontal and Lateral View (Dynamic View) The dynamics of smiling produce changes in the anatomic relationship of nose, Specially the relationship of tip and ala base.Upper lip Depressor Septi Muscle 41

42. Cephalic View The view highlights external nasal deformities and reveal deviations that are not appear in frontal view. In this view, the eyebrows are used to align patient Horizontally. 42

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48. Current Trends in Photography Clinical photography, use of 3-dimensional (3D) and 4-di- mensional (4D) patient modeling , and widening implementation of cloud-based storage and artificial intelligence (AI) Currently, 3D and 4D photography devices offer advantages such as improved communication to the patient on outcome expectation and better quality of patient service and safety. AI may contribute to post-capture processing and 3D printing of postoperative outcomes. Current smartphones distort patient perceptions about their appearance and should be used cautiously in an aesthetic surgery setting. Cloud-based storage provides flexibility, cost, and ease of service while remaining vulnerable to data breaches. 48

49. Limitations of 2D Medium Lack Creating an accurate 3D mental model from 2D photos Inability to address facial depth and nasal shaping Inability to objectively quantify treatment results 49

50. Morphing Software MGI Photosuite II,III,IV Adobe Photoshop Gunter Rhinoplasty Module Alter Image Mirror Imaging Systems 50

51. 51 There are numerous 3D systems currently used in aesthetic surgery including the Vectra XT, H2 (Canfield Scientific Inc., Fairfield, NJ), Crisalix VR 4D systems ( Crisalix SA, Lausanne, Switzerland), 3dMD (3dMD Inc, Atlanta, GA), and Morpheus 3D (Morpheus 3D Co., Ltd, Seongnam , South Korea) 

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54. Take Home Message Clinical photography is an important tool in cosmetic surgery. While there are advancements to be made in the physical equipment and preparation for the photograph, the future of clinical photography will be heavily influenced by innovations in software. Three-dimensional imaging has provided clinicians with insight into the structure of the patient body to an extent not seen previously, and continued advancements in AI modeling and more insightful imaging software will continue to drive future clinical decisions. Double Edged Sword and to be used carefully. 54

55. The surgeon should not Be detached what he can performwhile surgery vs computer Impression that images represent the nose will look exactly like this after operation. 55

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58. http:// academic.oup.com / asjopenforum /article-lookup/ doi /10.1093/ asjof /ojab050 58 http

59. SURGICAL PLANNING & SELECT MANEUVERS : TOP TO BOTTOM Upper third Hump - rasp vs osteotome Width - Lateral/medial osteotomies Deviation - Lateral, medial, intermediate osteotomies Middle third Hump - sharp incision, with reformation of continuity between ULC and septum Width-Spreader grafts, turn in flasp (auto-spreader), cartilage grafting Deviation-unilateral spreader grafts, high septal deviation, camouflage grafting Nasal valve patency - Spreader grafts, auto-spreaders, only graft Lower third Tripod concept Strength of tip cartilages-cephalic trim, scoring or incision to reduce strength, columellar strut, lateral crural strut to increase strength Tip defining points-inter and/or intradomal sutures to bring closer togther Bulbosity/convexity- cephalic trim to weaken +/- lateral crural strut graft to straighten Symmetry-columellar strut graft or tip graft; unilateral medial or lateral crural overlays Rotation-cephalic trim, lateral crural overlay, tip grafting Nasal valve patency-batten grafts, lateral crural strut grafts Septum 59

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