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    Software tools can educate, predict, and entertain, but beware patient expectations

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    Dr. Aarabi
    Seeing is believing — and where cosmetic surgery is concerned, that can be a problem in setting patient expectations. One of the emerging challenges that cosmetic surgeons face is managing expectations set by software programs in the hands of patients themselves. Increasingly sophisticated online imaging software programs — many available at no cost to the user — purport to give patients an idea of the "finished product." Prospective cosmetic patients can upload photographs of themselves and use the online controls to get an idea of how they might look after a certain aesthetic procedure.

    The keywords here are "idea" and "might." Those who help develop these tools are the first to label them as just that: tools.


    Dr. Vetter
    PREDICTIVE TOOLS One such tool is LiftMagic. Created by Modiface, Inc., LiftMagic is a free online system on which anyone can upload his or her picture and "try on" various cosmetic procedures via individual slider bars which adjust the degree of the effect desired from subtle to extreme. The individual's picture is then morphed to reflect the selections — flashing between both "before" and "after" images. Users can choose to alter their images for procedures from forehead enhancement to cheek lift, nose reduction, lip augmentation — even weight reduction. It even includes an option to let the software optimize the patient's image by selecting among all procedures — and to the optimal degree. "Although Modiface is not meant to replace the tools being used by plastic surgeons in their clinics," explains Parham Aarabi, Ph.D., CEO of Modiface Inc., and professor and Canada Research Chair, University of Toronto, "it aims to address all of those 'what if' questions that people have." Dr. Aarabi is acutely aware of the potential for prospective patients to read too much in to what they see. He tells Cosmetic Surgery Times that when he and his team began to create their technology, "We took every precaution to ensure that patients' expectations were appropriately dealt with. After all, our tools were fun and interactive visualizations for anyone to try, but not guaranteed or 100 percent accurate visualizations. After two years and over a million people having used our tools, I am glad that most of our users have understood exactly what our technology is and what it can and cannot do."

    He explains that surgeons have always had to manage patients' expectations, and advances in technology don't change that. "We simply provide a visual answer to anyone's 'what if' questions. We do not aim to sell any particular surgery or procedure. Our tools fall mainly in the pre-consultation path."

    PROGRAM PURPOSE "The technology is not really there to make an exact prediction," concurs Thomas Vetter, Ph.D., Graphics and Vision Research Group, University of Basel, Basel, Switzerland. Among Dr. Vetter and his colleagues' developments are 2-D to 3-D graphic morphing software, by which facial characteristics and features from two-dimensional pictures are fused to make one universal image able to be rotated and altered in three dimensions.

    "Even if the software could predict what could be done, the surgeon has to so precisely operate to do the same thing [that the software was projecting]. The patient needs to know, this is not really reality — it's just maybe what I could look like. I think it's really dangerous if you show a photo of a patient, manipulate it and say, 'okay, this is what you will look like.' The technology is good, but it can't make an exact prediction," and patients need to be made to understand that, Dr. Vetter says.

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    Lisette Hilton
    Lisette Hilton is a writer in Boca Raton, Fla., who heads up her company, Words Come Alive.

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