The study, “Three-Dimensional Imaging of the Face: A Comparison Between Three Different Imaging Modalities,” sought to compare three commonly used 3-dimensional (3D) imaging systems in an attempt to determine the reproducibility and accuracy across the imaging modalities.1 The authors compared repeated images on the same imaging modality (reproducibility), and between the three different imaging systems (accuracy). Three-dimensional facial imaging is important to communicate morphologic characteristics and imbalances to a patient and their families. Additionally, performing a simulation of proposed changes can be a powerful use of this technology. The accuracy and reproducibility of the individual system, compared to another, is not necessarily important in this vain. However, for 3D research and quantitative analysis, especially of postoperative changes, reproducibility between images is important. For instance, to help discern postoperative changes, including decrease in edema with time, evaluating one vs another treatment intervention (Figure 1).2-6 Additionally, looking at the interface of bone and soft-tissue requires and accurate photographic capture (Figures 2-3).7-10 Figure 1. View largeDownload slide Three-dimensional photogrammetric assessment allows overlay of images from two different time points, especially to reveal and critique the postoperative changes that have occurred. (A) An example of superimposed pre- and 1-year postrhinoplasty 3D images of an 18-year-old man. The preoperative image is shadowed (note the hump and de-rotated tip). (B, C) The same pre- and postoperative images, shown side-by-side on lateral view, and (D, E) on oblique view. Figure 1. View largeDownload slide Three-dimensional photogrammetric assessment allows overlay of images from two different time points, especially to reveal and critique the postoperative changes that have occurred. (A) An example of superimposed pre- and 1-year postrhinoplasty 3D images of an 18-year-old man. The preoperative image is shadowed (note the hump and de-rotated tip). (B, C) The same pre- and postoperative images, shown side-by-side on lateral view, and (D, E) on oblique view. Figure 2. View largeDownload slide Side-by-side comparisons, registered by unchanged landmarks. Right lateral (A) pre- and (B) 2-year postrhinoplasty of a 22-year old woman. Figure 2. View largeDownload slide Side-by-side comparisons, registered by unchanged landmarks. Right lateral (A) pre- and (B) 2-year postrhinoplasty of a 22-year old woman. Figure 3. View largeDownload slide Comparison of (A, C, E) pre- and (B, D, F) 1-year postrhinoplasty for a deviated nose in a 16-year old woman. Figure 3. View largeDownload slide Comparison of (A, C, E) pre- and (B, D, F) 1-year postrhinoplasty for a deviated nose in a 16-year old woman. The authors found that the 3dMDface system and Vectra XT demonstrated the highest reproducibility, with no statistically significant difference noted in the average differential measurements of these two imaging systems. The Artec Eva demonstrated a higher average deviation (0.26 ± 0.24 mm) as compared to the 3dMDface (0.18 ± 0.15 mm) and Vectra XT (0.15 ± 0.15 mm) systems, with achievement of statistically significance. To determine accuracy across systems, the authors used the 3dMDface system as the “gold standard,” despite this system demonstrating slightly more variability as compared to the Vectra system. There was no statistically significant difference between these two systems, and the 3dMDface system is covered extensively in the literature, leading the authors to choose this as the standard by which they measured their results. Although well reasoned and appropriately chosen, having any one system as the standard bearer supposes its accuracy as an ideal. The actual “gold standard” would be calipered measurements of the facial proportions of interest, and a comparison of the imaging modalities measurements to “live” calculations and proportions, to determine “true” accuracy. The authors found that the Artec Eva accuracy compared to the 3dMDface system was less accurate as compared to the Vectra system. The influence of the imaging capture modality is addressed as a possible source of error, and is likely a significant contributor to lagging reproducibility of image capture. The Artec Eva requires the subject be physically scanned, and there is inherent user variability between shots, possibly leading to additional variance in the acquired photographs. Similarly, there may be variability in subjects positioning between image acquisitions that may impact all imaging system modalities. These variables may confound or add to the differences attributed to the imaging systems. A further test that may help elucidate the imaging systems reproducibility and accuracy, would be capture and comparisons of still life imagery to ameliorate potential confounding, and serve as an internal control. An interesting omission is the lack of inclusion of data from the periorbital regions. These anatomical regions are routinely noted to have errors and nonuniform 3D imaging. This may be due to several factors, including the complexity of the 3D relationships of this area, shadowing, blinking, and small size of the eyelashes among others, leading to errors in reproducibility from 3D image to 3D image. Unfortunately given the study and technological limitations, this remains an unexplored but important area of investigation. The authors conclude that the differences they found are within the known differences of sequential image capture of 0.25 mm, and are under clinically relevant measurements of 0.5 mm. While these are valid points, they should not lead us all to be satisfied with the currently available imaging modalities, nor accept our current imaging limitations. Importantly, inaccuracy in the periorbital region, lack of exact registration for sequential imaging, and inadequate image simulations point to areas for improvement in software algorithms for all three systems. The authors also conclude that the differences in reproducibility and accuracy between the systems are not clinically relevant, and are able to be used simultaneously in multicenter studies. While under certain situations this may be true, we respectfully disagree with this assertion as a concluding statement. Given the user variability and decreased reproducibility and accuracy of the Artec Eva system, its potential variance may not make it a comparable imaging modality when expert users are not at the helm. Allowing for all systems to have equivalency across institutional study would not allow for reader understanding of the important distinctions and limitations of each imaging system. Ultimately, the authors are to be commended for their well executed and important study comparing three popular imaging modalities. They provide novel, important data that will allow readers to draw well studied, informed decisions about which 3D imaging systems to invest in for their practice, while understanding the potential pitfalls of comparing results among systems over time. Disclosures The authors declared no potential conflicts of interest with respect to the research, authorship, and publication of this article. Funding The authors received no financial support for the research, authorship, and publication of this article. REFERENCES 1. Verhulst A , Hol M , Vreeken R , Becking A , Ulrich D , Maal T . Three-dimensional imaging of the face: a comparison between three different imaging modalities . Aesthet Surg J . 2018 ; 38 ( 6 ): 579 - 585 . 2. Pavri S , Zhu VZ , Steinbacher DM . Postoperative Edema Resolution following Rhinoplasty: A Three-Dimensional Morphometric Assessment . Plast Reconstr Surg . 2016 ; 138 ( 6 ): 973e - 979e . Google Scholar CrossRef Search ADS PubMed 3. Cabrejo R , DeSesa CR , Sawh-Martinez R , Steinbacher DM . Does Fat Grafting Influence Postoperative Edema in Orthognathic Surgery ? J Craniofac Surg . 2017 ; 28 ( 8 ): 1906 - 1910 . Google Scholar CrossRef Search ADS PubMed 4. Shah A , Pfaff M , Kinsman G , Steinbacher DM . Alar-columellar and lateral nostril changes following tongue-in-groove rhinoplasty . Aesthetic Plast Surg . 2015 ; 39 ( 2 ): 191 - 198 . Google Scholar CrossRef Search ADS PubMed 5. Metzler P , Geiger EJ , Chang CC , Sirisoontorn I , Steinbacher DM . Assessment of three-dimensional nasolabial response to Le Fort I advancement . J Plast Reconstr Aesthet Surg . 2014 ; 67 ( 6 ): 756 - 763 . Google Scholar CrossRef Search ADS PubMed 6. DeSesa CR , Metzler P , Sawh-Martinez R , Steinbacher DM . Three-dimensional Nasolabial Morphologic Alterations Following Le Fort I . Plast Reconstr Surg Glob Open . 2016 ; 4 ( 8 ): e848 . Google Scholar CrossRef Search ADS PubMed 7. Steinbacher DM . Three-dimensional analysis and surgical planning in craniomaxillofacial surgery . J Oral Maxillofac Surg . 2015 ; 73 ( 12 Suppl ): S40 - S56 . Google Scholar CrossRef Search ADS PubMed 8. Metzler P , Geiger EJ , Alcon A , Ma X , Steinbacher DM . Three-dimensional virtual surgery accuracy for free fibula mandibular reconstruction: planned versus actual results . J Oral Maxillofac Surg . 2014 ; 72 ( 12 ): 2601 - 2612 . Google Scholar CrossRef Search ADS PubMed 9. Pfaff MJ , Steinbacher DM . Plastic surgery resident understanding and education using virtual surgical planning . Plast Reconstr Surg . 2016 ; 137 : 258e - 9e . Google Scholar CrossRef Search ADS PubMed 10. Pfaff MJ , Steinbacher DM . Plastic Surgery Applications Using Three-Dimensional Planning and Computer-Assisted Design and Manufacturing . Plast Reconstr Surg . 2016 ; 137 ( 3 ): 603e - 616e . Google Scholar CrossRef Search ADS PubMed © 2018 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: email@example.com This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices)
Aesthetic Surgery Journal – Oxford University Press
Published: Mar 14, 2018
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