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

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We read with extreme interest the article by Weissler et al, entitled “The Evolution of Photography and Three-Dimensional Imaging in Plastic Surgery” published in the March of 2017 issue of the Journal.1 We congratulate the authors for this ambitious undertaking, which presents a historical review of the fascinating progress made in photography in plastic surgery and highlights the clinical utility of three-dimensional imaging in our practice. As observed in the article, this technology appears to be the most appropriate to provide an objective evaluation of outcomes, especially when a volume change is included as a primary goal of the operation. The implications for procedures such as fat grafting are certainly remarkable, as a volumetric and morphologic analysis demonstrating true surface dimensions both preoperatively and postoperatively becomes available. Among the many, one of those implications refers to clinical studies reporting or comparing fat graft survival achieved using different techniques, which in the future will require documentation with objective measures of the recipient-site volume at the baseline and at postoperative follow-up visits.
In this regard, we recently introduced in our practice an extremely inexpensive and easily handled device and a three-dimensional imaging elaboration process that were not mentioned in the article by Weissler and colleagues. We perform our scanning process through an instrument connected to an iPad Pro (Apple, Inc., Cupertino, Calif.) called Structure Sensor 3D scanner (Occipital, Inc., Boulder, Colo.), a structured/infrared light handheld scanner that measures 11.92 (width) × 2.9 (height) × 2.8 (depth) cm and has a weight of 95 g, available at a price of $379 (Fig. 1). We regularly use the device to assess volume change in the fat graft recipient site when a moderate volume of fat is transplanted to treat breast surgery sequelae, such as contracted scar, and a precise evaluation is needed for adequate outcome estimation.2–4 Three-dimensional images are then elaborated using a three-dimensional mesh-processing application called MeshLab 2016, which is available as open-source software, to clean the three-dimensional raw data and calculate body volumes. Calculations for the breast are performed according to mammometrics landmarks described in this Journal by Tepper et al.5 in 2010 (Fig. 2).
We believe that our approach could easily become part of the everyday plastic surgery practice, not just in the academic setting but even in private, because of the very limited dimensions and cost of the instrument and its simple handling, especially compared with other options listed by Weissler et al.1 However, our procedure only allows volume calculations and therefore evaluation of baseline conditions and acquired outcomes, and not simulation of predicted outcomes, to be shown preoperatively to the patient, which is instead possible with a similar but more expensive technology such as Crisalix (Crisalix Virtual Aesthetics, Bern, Switzerland). In conclusion, as for many other innovations throughout history, we observe that the role of plastic surgery among medical specialties is at the forefront in implementing this hot topic technology, which belongs to the field of augmented reality and aims at providing a computer-mediated reality, where physical elements of the real world are supplemented by computer-generated sensory inputs.
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