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Realistic Expectations: To Morph or Not to Morph?

Background: The purpose of this study was to determine whether computer-morphed images convey realistic expectations of the postoperative cosmetic result to patients seeking rhinoplasty. Methods: This was a retrospective study in which preoperative, computer-morphed, and 1-year postoperative images of 25 consecutive rhinoplasty patients were analyzed by 12 anonymous, skilled observers and by the operating surgeon in a double-blind fashion. Each patient's photographs were accompanied by an identical four-question survey. The survey assessed whether the morphed image represented an obtainable goal, the degree of similarity between the morphed image and the actual postoperative result, and the quality of the surgical outcome as compared with the computer image. Results: As expected based on variations in individual surgeons' aesthetic opinions, the cumulative data from the 12 blinded raters across all patients indicated that 82 percent of the raters would have performed the imaging in either the same way or, at most, a “slightly different” way from the operating surgeon. Approximately half thought that the computer-morphed image did realistically predict the postoperative result but that it could be a bit closer. Seventy-five percent felt that the actual surgical result was either the same as or better than the predicted result. Conclusions: Computer imaging for patients undergoing rhinoplasty does portray a realistic picture of the anticipated cosmetic result. However, because an average of 32 percent of respondents felt that the computer-morphed image did not predict the postoperative result, conservative imaging is encouraged to prevent false expectations.