The Application of Three-Dimensional Surface Imaging System in Plastic and Reconstructive Surgery

Frontiers in Three-Dimensional Surface Imaging Systems for 3D Face Acquisition in Craniofacial Research and Practice: An Updated Literature Review

Digitalizing all aspects of dental care is a contemporary approach to ensuring the best possible clinical outcomes. Ongoing advancements in 3D face acquisition have been driven by continuous research on craniofacial structures and treatment effects. An array of 3D surface-imaging systems are currently available for generating photorealistic 3D facial images. However, choosing a purpose-specific system is challenging for clinicians due to variations in accuracy, reliability, resolution, and portability. Therefore, this review aims to provide clinicians and researchers with an overview of currently used or potential 3D surface imaging technologies and systems for 3D face acquisition in craniofacial research and daily practice. Through a comprehensive literature search, 71 articles meeting the inclusion criteria were included in the qualitative analysis, investigating the hardware, software, and operational aspects of these systems. The review offers updated information on 3D surface imaging technologies and systems to guide clinicians in selecting an optimal 3D face acquisition system. While some of these systems have already been implemented in clinical settings, others hold promise. Furthermore, driven by technological advances, novel devices will become cost-effective and portable, and will also enable accurate quantitative assessments, rapid treatment simulations, and improved outcomes.

Comparison of three-dimensional imaging of the nose using three different 3D-photography systems: an observational study

BACKGROUND

New 3D technologies for superficial soft tissue changes, especially in plastic and reconstructive surgical procedures, can improve the planning and documentation of facial surgeries. The purpose of this study was to compare and determine the applicability and feasibility of three different 3D-photography systems in clinical practice imaging the nose.

METHODS

A total of 16 healthy non-operated noses were included in this prospective study. A plaster model of each nose was produced, digitized, and converted to a .stl mesh (= ground truth model). Three-dimensional images of each nose were then taken using Artec Space Spider (gold standard), Planmeca ProFace®, and the Bellus3D Dental Pro application. All resulting .stl files were aligned to the ground truth model using MeshLab software, and the root mean square error (RMSE), mean surface distance (MSD), and Hausdorff distance (HD) were calculated.

RESULTS

The Artec Space Spider 3D-photography system showed significantly better results compared to the two other systems in regard to RMSE, MSD, and HD (each p < 0.001). There was no significant difference between Planmeca ProFace® and Bellus3D Dental Pro in terms of RMSE, MSD, and HD. Overall, all three camera systems showed a clinically acceptable deviation to the reference model (range: -1.23-1.57 mm).

CONCLUSIONS

The three evaluated 3D-photography systems were suitable for nose imaging in the clinical routine. While Artec Space Spider showed the highest accuracy, the Bellus3D Dental Pro app may be the most feasible option for everyday clinical use due to its portability, ease of use, and low cost. This study presents three different systems, allowing readers to extrapolate to other systems when planning to introduce 3D photography in the clinical routine.

Craniofacial Growth and Asymmetry in Newborns: A Longitudinal 3D Assessment

OBJECTIVE

To evaluate the development of the craniofacial region in healthy infants and analyze the asymmetry pattern in the first year of life.

METHODS

The participants were grouped by sex and age (1, 2, 4, 6, 9, and 12 months) to receive three-dimensional (3D) photographs. Stereoscopic craniofacial photos were captured and transformed into a series of craniofacial meshes in each group. The growth patterns of the anthropometric indices and the degree of craniofacial asymmetry were measured, and average craniofacial meshes and color-asymmetry maps with craniofacial asymmetry scores were calculated.

RESULTS

A total of 373 photographs from 66 infants were obtained. In both genders, the highest and lowest growth rates for all anthropometric indices were noted between 1 and 2 months and between 9 and 12 months, respectively. Overall, male infants had higher anthropometric indices, head volume, and head circumference than female infants. The craniofacial asymmetry score was presented with a descending pattern from 1 to 12 months of age in both sex groups. Both sex groups showed decreased left-sided laterality in the temporal-parietal-occipital region between 1 and 4 months of age and increased right frontal-temporal prominence between 6 and 12 months of age.

CONCLUSIONS

A longitudinal evaluation of the craniofacial growth of healthy infants during their first year of life was presented.

Injectable platelet-rich fibrin for perioral rejuvenation as assessed by 3D lip volume imaging

BACKGROUND

Various injectable autologous platelet aggregate preparations have been developed and used for facial rejuvenation. Limited evidence exists for the use of these for augmentation of the lip.

OBJECTIVES

This prospective, uncontrolled, single-center study evaluated the qualitative and quantitative effects of an injectable platelet-rich fibrin preparation (known as i-PRF+) for lip augmentation.

PATIENTS/METHODS

PRF^® PROCESS system technology was used to prepare i-PRF+ supernatant. Ten healthy females were included in the study and received a single intradermal injection of i-PRF+ in the upper and lower lips (5 ml in each quadrant, total ~2 ml). Participants were followed for 3 months post-procedure. The efficacy of the procedure was assessed qualitatively by a subjective patient-reported outcome (FACE-Q) assessment and quantitatively by objective 3D skin surface volume analysis (ProFace^® ) at baseline and after 3 months.

RESULTS

FACE-Q scales that measure satisfaction with skin and lip showed a statistically significant improvement from baseline (p = 0.04 and p = 0.02, respectively). Satisfaction with lip lines showed a numerical improvement with mean total scores for adverse effect scales related to the skin and lips reduced at 2 weeks post-procedure (p = 0.03 and p = 0.13, respectively). Overall lip volume at 3-month follow-up was unchanged (p = 0.11). The treatment was well tolerated with only minor adverse effects.

CONCLUSIONS

A single session of i-PRF+ injections resulted in significant lip rejuvenation at 3-month follow-up, shown by improved patient-reported outcome measure. No significant change in lip volume was observed.

The current progress and critical analysis of three-dimensional scanning and three-dimensional printing applications in breast surgery

Background

Several attempts have been made to develop a tool capable of evaluating breast shape and volume to aid surgical planning and outcome assessment. More recently, newer technologies such as three-dimensional (3D) scanning and 3D printing have been applied in breast assessment. The aim of this study was to review the literature to assess the applicability of 3D scanning and 3D printing in breast surgery.

Methods

A literature search was carried on PubMed, Google Scholar and OVID from January 2000 to December 2019 using the keywords ‘3D’, ‘Three-dimensional’, ‘Three/four dimensions’ and ‘Breast’.

Results

A total of 6564 articles were identified initially; the abstracts of 1846 articles were scanned, and 81 articles met the inclusion criteria and were included in this review. Articles were reviewed and classified according to their aims, study subjects, the software and hardware used, main outcomes and major limitations.

Conclusions

These technologies are fast and easy to use, however, high costs, long processing times and the need for training might limit their application. To incorporate these technologies into standard healthcare, their efficacy and effectiveness must be demonstrated through multiple and rigorous clinical trials.

Three-dimensional Printing in Plastic Surgery: Current Applications, Future Directions, and Ethical Implications

Background

Three-dimensional printing (3DP) is a rapidly advancing tool that has revolutionized plastic surgery. With ongoing research and development of new technology, surgeons can use 3DP for surgical planning, medical education, biological implants, and more. This literature review aims to summarize the currently published literature on 3DP's impact on plastic surgery.

Methods

A literature review was performed using Pubmed and MEDLINE from 2016 to 2020 by 2 independent authors. Keywords used for literature search included 3-dimensional (3D), three-dimensional printing (3DP), printing, plastic, surgery, applications, prostheses, implants, medical education, bioprinting, and preoperative planning. All studies from the database queries were eligible for inclusion. Studies not in English, not pertaining to plastic surgery and 3DP, or focused on animal data were excluded.

Results

In total, 373 articles were identified. Sixteen articles satisfied all inclusion and exclusion criteria, and were further analyzed by the authors. Most studies were either retrospective cohort studies, case reports, or case series and with 1 study being prospective in design.

Conclusions

3DP has consistently shown to be useful in the field of plastic surgery with improvements on multiple aspects, including the delivery of safe, effective methods of treating patients while improving patient satisfaction. Although the current technology may limit the ability of true bioprinting, research has shown safe and effective ways to incorporate biological material into the 3D printed scaffolds or implants. With an overwhelmingly positive outlook on 3DP and potential for more applications with updated technology, 3DP shall remain as an effective tool for the field of plastic surgery.

New Horizons in Imaging and Diagnosis in Rhinoplasty

Three-dimensional (3D) surface imaging has found its place in aesthetic surgery globally. The first attempt to use 3D surface imaging technique in clinic was in 1944 by Thalmaan, who used stereo photogrammetry to examine an adult with facial asymmetry and a baby with Pierre Robin syndrome. Three-dimensional photography is becoming more common allowing for a more dynamic facial evaluation, although it is associated with increased cost.

Isolated Fat Grafting for Reconstruction of Lower Face Volumetric Asymmetry in Skeletally Immature Patients: A Clinical Outcome Study

BACKGROUND

The purpose of this study was to assess the objective and subjective outcomes of lower face volumetric (contour) asymmetry correction with isolated fat grafting in skeletally immature patients.

METHODS

A prospective analysis was conducted of skeletally immature patients (n = 73) with craniofacial microsomia and Parry-Romberg syndrome who underwent isolated fat grafting (with no previous or concomitant bone surgery) using anatomical surgical principles (facial subunits and fat compartments) for the reconstruction of lower face volumetric asymmetry. Objective ultrasound and photogrammetric lower face symmetry analyses were blindly performed preoperatively and at 3 and 12 months postoperatively. A panel assessment of blinded surgical professionals and laypersons was also obtained to grade the subjective lower face symmetry.

RESULTS

There were significant (all P < 0.05) postoperative objective and subjective lower face symmetry enhancements (preoperative < postoperative) after isolated fat grafting, with no differences (all P > 0.05) between 3 versus 12 months' postoperative comparisons.

CONCLUSIONS

Growing patients with unilateral lower face volumetric asymmetries presented with improvement of objective and subjective symmetry after a single isolated fat grafting procedure.

Reliability of optical devices for three-dimensional facial anatomy description: a systematic review and meta-analysis

The use of three-dimensional (3D) optical instruments to measure soft tissue facial characteristics is increasing, but systematic assessments of their reliability, practical use in research and clinics, outcome measurements, and advantages and limitations are not fully established. Therefore, a review of the current literature was performed on the reliability of facial anthropometric measurements obtained by 3D optical facial reproductions as compared to conventional anthropometry or other optical devices. The systematic literature search was conducted in electronic databases following the PRISMA guidelines (PROSPERO registration: CRD42018085473). Overall, 815 studies were identified, with 27 final papers included. Two meta-analyses were conducted. Tested devices included conventional cameras, laser scanning, stereophotogrammetry, and structured light. Studies measured living people or inanimate objects. Overall, the optical devices were considered reliable for the measurement of linear distances. Some caution is needed for surface assessments. All instruments are suitable for the analysis of inanimate objects, but fast scan devices should be preferred for living subjects to avoid motion artefacts in the orbital and nasolabial areas. Prior facial landmarking is suggested to improve measurement accuracy. Practical needs and economic means should direct the choice of the most appropriate instrument. Considering the increasing interest in surface-to-surface measurements, fast scan devices should be preferred, and dedicated protocols devised.

Clinical Application of Precise Composite Breast Augmentation

OBJECTIVE

For thin women with little subcutaneous fat and micromastia, they could not obtain ideal results by choosing autologous fat breast augmentation or prosthesis-only breast augmentation. To address these problems, we combined autologous fat and prosthesis for breast augmentation, and the clinical results were satisfactory.

METHODS

Eleven cases of composite breast augmentation from 2014 to 2017 were analyzed retrospectively. Postoperative follow-up and evaluation were completed. The operations were performed through a subaxillary incision, and the round, high-convex breast prostheses were implanted into the retropectoralis major space. Autologous fat was injected into subcutaneous, retromammary, and prepectoralis layers to cover the whole breast before and after implanting the prosthesis.

RESULTS

The mean follow-up period was 16 months (range, 6-36 months). All patients were satisfied with the size of their breasts. Postoperative complications such as infection, vascular embolism, delayed healing incision, hematoma, and seroma were not detected. In 1 case, the sensation of a unilateral nipple-areola was decreased initially but recovered after 4 months. Long-term complications such as capsular contracture, palpable nodules, double-bubble deformity, asymmetry, poor handling, implant edge visibility, and palpability also did not occur.

CONCLUSION

Breast augmentation combining autologous fat and prosthesis was safe and could achieve aesthetically satisfactory results.

Lip Morphology and Aesthetics: Study Review and Prospects in Plastic Surgery

The lip profile plays an important role in the perception of facial aesthetics; lip morphology and aesthetics research is receiving increasing attention. The advancement of research tools such as three-dimensional imaging technology has led to the clarification of lip morphologic and aesthetic characteristics. After studies of lip characteristics according to gender, ethnicity and age provided basic data, studies on lip aesthetics have been conducted by scholars worldwide. These studies could provide a basic theory to support diagnosis and treatment options, as well as the basis for evaluative criteria for precise treatment and technical improvements. According to the conclusions of the above studies, new ideas for cosmetic surgery design, including lip, perioral and labial-facial relationships, have been discovered.Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

An ad hoc three dimensionally printed tool facilitates intraesophageal suturing in experimental surgery

BACKGROUND

Three-dimensional printing (3DP) has become popular for development of anatomic models, preoperative planning, and production of tailored implants. A novel laparoscopic, transgastric procedure for distal esophageal mucosectomy was developed. During this procedure, a space holder had to be introduced into the distal esophagus for exposure during suturing. The production process and evaluation of a 3DP space holder are described herein.

MATERIALS AND METHODS

Computer-aided design software was used to develop models printed from polylactic acid. The prototype was adapted after testing in a cadaveric model. Subsequently, the device was evaluated in a nonsurvival porcine model. A mucosal purse-string suture was placed as orally as possible in the esophagus, in the intervention group with and in the control group without use of the tool (n = 8 each). The distance of the stitches from the Z-line was measured. The variability of stitches indicated the suture quality.

RESULTS

The median maximum distance from the Z-line to purse-string suture was larger in the intervention group (5.0 [3.3-6.4] versus 2.4 [2.0-4.1] cm; P = 0.013). The time taken to place the sutures was shorter in the control group (P < 0.001). Stitch variance tended to be greater in the intervention group (2.3 [0.9-2.5] versus 0.7 [0.2-0.4] cm; P = 0.051). The time required for design and production of a tailored tool was less than 24 h.

CONCLUSIONS

3DP in experimental surgery enables rapid production, permits repeated adaptation until a tailored tool is obtained, and ensures independence from industrial partners. With the aid of the space holder more orally located esophageal lesions came within reach.