Morphing patient images to offer some demonstration of the intended surgical outcome can support shared expectations between patient and facial plastic surgeon. As part of the preoperative consultation, showing a patient an image that compares their face before surgery with what is planned after surgery can greatly enhance the surgical experience. This article refers to use of Photoshop CS3 for tutorial descriptions but any recent version of Photoshop is sufficiently similar. Among the topics covered are creating a before-and-after, rhinoplasty imaging, face- and brow-lift imaging, and removing wrinkles. Each section presents a step-by-step tutorial with graphic images demonstrating the computer screen and Photoshop tools.
Much of the success in facial plastic surgery comes from having a set of shared expectations with the patient. Offering some demonstration of the intended surgical outcome has long been a part of the preoperative consultation. Morphing patient images is a huge improvement over drawing on a Polaroid with a Sharpie. Many companies have developed software to make patient image manipulation simpler. Typically these programs cost several thousands of dollars and some of them store their images in proprietary data formats. They are attractive to many surgeons because they offer a prepackaged solution for what seems like a daunting task. Many facial plastic surgeons already have Adobe Photoshop (Adobe Systems Inc, San Jose, CA, USA) for image editing and are unaware that it can do everything that the proprietary systems can. With some scripting, Photoshop can effectively mimic the more task-specific alternatives at a lower price. This article refers to use of Photoshop CS3 for descriptions but any recent version of Photoshop is sufficiently similar. Video tutorials and Photoshop actions for morphing can be found at http://www.granthamilton.com/UIFPS/Morph.html .
Ethical considerations in patient imaging
Ideally, preoperative photographs should be manipulated to enhance communication with the patient and not to sell surgery. Showing a change that is surgically unlikely is not only misleading but will do nothing to create a happy patient. With that in mind, it is reasonable to leave some imperfections in the manipulated image to reinforce the expectation that the surgical goal is improvement and not perfection. It is also a good idea to do your own imaging. Some surgeons may have their fellow or a patient-care coordinator manipulate the images. Having the experience of previous surgical cases creates a more realistic and accurate prediction of the surgical result. A well-defined tip in a thick-skinned patient is easy to show with the computer but, in reality, would be an unlikely surgical outcome. There is also some controversy about whether or not the images should be printed and given to the patient. Proponents believe that providing the patient with a copy may make the psychological adjustment to the postoperative result smoother and may stimulate informed questions. Others think that giving the images to the patient may expose them to litigation if the images are misconstrued as a guarantee.
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