Digital imaging in rhinoplasty

Imaging in facial plastic surgery is becoming common. With the advances of digital imaging software, modifications of preoperative images for rhinoplasty patients can help to predict outcomes. The primary objective of this study was to determine whether preoperative digital image modification in rhinoplasty patients is useful in predicting postoperative outcomes.

Patients undergoing rhinoplasty were prospectively collected and underwent preoperative digital imaging modifications using computer software. Postoperative images were compared to the preoperative modified images. Rankings for similarity were performed by patients and surgeons. Wilcoxon ranked-pairs test was used to compare the groups with a predetermined P value of 0.05, and levels of agreement were assessed using weighted kappa scores.

One hundred twelve patients were collected and postoperative images were taken 11 months after surgery (range = 6-30 months). Frontal images were rated as poor, average, very close, or identical by patients 6.2, 52.7, 33.0, and 8.0%, and by surgeons 2.7, 61.6, 34.8, and 0.9%, respectively (Wilcoxon test, P = 0.23). Lateral images were rated as poor, average, very close, or identical by patients 1.8, 18.8, 48.2, and 31.3%, and by surgeons 0.9, 24.1, 59.8, and 15.2%, respectively (Wilcoxon test, P = 0.0024). Weighted kappa scores for agreement were 0.42 for frontal views of patients and surgeons and 0.65 for lateral views.

Ratings by patients and surgeons comparing preoperative manipulated images with postoperative outcomes are predictive in approximately 75% of the patients, and lateral images are more useful for this goal. Level of agreement between patient and surgeon scoring is good for lateral images and moderate for frontal.