Jillian E. Schreiber

The Evolution of Photography and Three-dimensional Imaging in Plastic Surgery

Summary: Throughout history, the technological advancements of conventional clinical photography in plastic surgery have not only refined the methods available to the plastic surgeon, but have invigorated the profession through technology. The technology of the once traditional two-dimensional photograph has since been revolutionized and refashioned to incorporate novel applications, which have since become the standard in clinical photography. Contrary to traditional standardized two-dimensional photographs, three-dimensional photography provides the surgeon with an invaluable volumetric and morphologic analysis by demonstrating true surface dimensions both preoperatively and postoperatively. Clinical photography has served as one of the fundamental objective means by which plastic surgeons review outcomes; however, the newer three-dimensional technology has been primarily used to enhance the preoperative consultation with surgical simulations. The authors intend to familiarize readers with the notion that three-dimensional photography extends well beyond its marketing application during surgical consultation. For the cosmetic surgeon, as the application of three-dimensional photography continues to mature in facial plastic surgery, it will continue to bypass the dated conventional photographic methods plastic surgeons once relied on. This article reviews a paradigm shift and provides a historical review of the fascinating evolution of photography in plastic surgery by highlighting the clinical utility of three-dimensional photography as an adjunct to plastic and reconstructive surgery practices. As three-dimensional photographic technology continues to evolve, its application in facial plastic surgery will provide an opportunity for a new objective standard in plastic surgery.

3D Topographical Surface Changes in Response to Compartmental Volumization of the Medial Cheek; Defining a Malar "Augmentation Zone".

Background: Given the widespread use of facial fillers and recent identification of distinct facial fat compartments, a better understanding of three-dimensional surface changes in response to volume augmentation is needed. Advances in three-dimensional imaging technology now afford an opportunity to elucidate these morphologic changes for the first time. Methods: A cadaver study was undertaken in which volumization of the deep medial cheek compartment was performed at intervals up to 4 cc (n = 4). Three-dimensional photographs were taken after each injection to analyze the topographic surface changes, which the authors define as the “augmentation zone.” Perimeter, diameter, and projection were studied. The arcus marginalis of the inferior orbit consistently represented a fixed boundary of the augmentation zone, and additional cadavers underwent similar volumization following surgical release of this portion of the arcus marginalis (n = 4). Repeated three-dimensional computer analysis was performed comparing the augmentation zone with and without arcus marginalis release. Results: Volumization of the deep medial cheek led to unique topographic changes of the malar region defined by distinct boundaries. Interestingly, the cephalic border of the augmentation zone was consistently noted to be at the level of the arcus marginalis in all specimens. When surgical release of the arcus marginalis was performed, the cephalic border of the augmentation zone was no longer restricted. Conclusions: Using advances in three-dimensional photography and computer analysis, the authors demonstrate characteristic surface anatomy changes in response to volume augmentation of facial compartments. This novel concept of the augmentation zone can be applied to volumization of other distinct facial regions. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.

A Novel Approach to Surgical Markings Based on a Topographic Map and a Projected Three-dimensional Image.

Summary: Surgical markings play a crucial role in the planning of plastic surgery procedures.1–4 However, despite their importance, they are often imprecise. For instance, when assessing patients in need of autologous fat grafting, surgeons often base markings on estimations of where volume deficiency exists and how much volume will correct the deficiency. In this article, the authors describe a novel approach to lipostructure, guided by a computer-based roadmap. A digital three-dimensional topographic surgical map is created using three-dimensional photography and analytic software and then projected as an image onto the patient in the operating room. This unique concept can be applied to most soft-tissue procedures in plastic surgery. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.

A Novel Approach to Surgical Markings Based on a Topographical Map and a Projected 3D Hologram.

Purpose: Surgical markings play a crucial role in planning plastic surgery procedures.[1, 2] Despite the importance of markings as a guide, these surgical markings are often imprecise. [3] Herein we describe a novel approach to lipostructure, guided by a computer-based roadmap. A digital 3D topographical surgical map is created using 3D photography and analytic software and then projected as an image onto the patient in the OR during surgery. This concept can be applied to most soft tissue procedures in plastic surgery.

A Novel 3D Analysis of Arcus Marginalis Release for Midface Rejuvenation.

PURPOSE: Many experts believe the arcus marginalis plays a critical role in tear-trough deformity.1-5 Arcus marginalis release (AMR) is performed with fat repositioning to soften the lidcheek junction and achieve a more youthful midface contour. The following study used 3D photography and computer analysis to document changes in the tear-trough and midface contour in response to AMR with malar lipostructure.

3D Topographical Surface Changes of the Malar Region in Response to Compartmental Volumization of the Deep Medial and Lateral Cheek.

INTRODUCTION: Given the widespread use of facial fi llers, and identifi cation of distinct facial fat compartments1,2, a better understanding of 3D surface changes in response to volume augmentation is needed. The malar region is one such area commonly treated with autologous fat grafting or fi llers in which it is important to understand how compartmental volumization relates to topographical change.3,4