Polygonal girl head By Marianne Matthews

Imaging in cosmetic surgery is so much bigger than before-and-after photos. Today’s imaging tools run the gamut from in-house photography studios, to diagnostic and therapeutic tools, predictive imaging, and beyond. New technologies as well as new uses of existing imaging technologies are changing the way cosmetic surgery is practiced—and by and large, the best is yet to come.

Ultrasound in Theory and Practice

Cosmetic practices have been utilizing ultrasound for a variety of applications for well over a decade. Traditional ultrasound-guided procedures such as breast cyst aspiration, sclerotherapy, and endovenous laser ablation show no signs of going away. However, the real excitement is in the technology’s untapped potential.

Cosmetic surgeons are increasingly using ultrasound during liposuction to see where the cannula is being placed or when giving facial fillers, says Boston-based plastic surgeon Jane Petro, MD, a professor of surgery at New York Medical College. Going forward, the technology will also be used in fat transfers, like gluteal augmentation, as ultrasound can help guide the effective placement of fat in specific areas, she says.

“The opportunities are almost limitless,” she says. “The technology is getting easier, interpretation is getting better, the imaging is good quality, and the equipment is more affordable.”

Ultrasound-guided injections of non-opioid EXPAREL® from Pacira Pharmaceuticals—a slow-release pain medication for postoperative pain—help ensure the medication is injected at the right depth and level, adds Mark M. Youssef, MD, medical director, Younique Cosmetic Surgery, in Santa Monica, Calif.

Little Cameras, Big Uses

While they are not new, endoscopic cameras keep getting better. “There are continued improvements in cost, availability, and the quality of imaging,” Petro says. The trend is toward easier-to-use cameras with better resolution.

In the last 2 years, vendors have come out with endoscopes that attach to laptops and even iPhones. “It means we can make smaller incisions. For the patient, it’s less invasive and there are smaller scars,” Youssef says. Consider the difference between a coronal brow lift and an endoscopic brow lift. “Endoscopy has taken a horrific surgery and turned it into a mini-procedure.”

Simulation and Beyond

Savvy patients are requesting, if not demanding, technology that will show them what they will look like after surgery—be it a face lift, neck lift, rhinoplasty, eyelid surgery, or tummy tuck. But predictive imaging sets up a result, and that’s “a slippery slope,” says Joe Niamtu, III, DMD, FAAC, of Cosmetic Facial Surgery in Midlothian, Va. “If I were going to image someone—and I rarely do—I would say, ‘Here’s what we’re shooting for.’ ”

Simulation tools are “a double-edged sword,” agrees Youssef. “It creates good, informative consultations, but also sets up a whole new set of expectations.”
However, skin imaging tools can show a patient various areas of aging—age spots, uneven pigmentation, and wrinkles—“that you can’t see when you look in the mirror,” Niamtu says. Next-generation skin imaging coupled with quantitative analysis technologies will continue to serve a critical purpose as a motivator, diagnostic tool, and an evaluation tool to determine how well a procedure worked, he says.

Hot Off the Printer

3D printing is one of the most promising up-and-coming technologies for cosmetic surgery. While Niamtu uses plenty of off-the-shelf implants, he also has a facial CT scanner in his office that allows him to capture images of a patient’s cheek, for example, and then sends them out to a vendor who makes a custom implant. It costs more—around double—but some patients are willing to foot the bill as custom implants fit better.

“We’re going to be able to print out customizable body parts in the office,” he says. Cosmetic surgeons will have the ability to print cheek, chin, jaw, and nose implants, and even mirror-image ears to match a missing ear lost in an accident, he predicts.

Marianne Matthews is a contributing writer for Plastic Surgery Practice magazine. She can be reached via PSPeditor@allied360.com.