With self-driving cars, phones that control your lights, speakers that order your favorite things, and headsets that can take you on a virtual journey, we are living in the future. So of course the beauty industry, which is always on the cutting edge, has one foot in this new world. Pre-treatment 3D imaging lets you virtually try on a look before you commit to a treatment. Double board certified plastic surgeon to the rich and famous Dr. David Shafer, who was one of the first doctors to start using this technology for his patients in New York City, gives us the scoop on this ground breaking technique as he takes me through the process.
How does 3D imaging work?
It's really gaining ground as computer processing and imaging techniques are now able to create realistic 3D images for patients to visualize their potential results. A leader is Canfield VECTRA 3D imaging where patients can see not only their skin texture and pores in high definition but also any sun damage or underlying vascular issues such as rosacea and capillaries.
I'm afraid of seeing myself in 3D. Some days 2D is difficult enough. Please tell me it won’t be that bad.
I’ll tell you, many patient’s are scared at first, but then they really start to get into it. You can zoom in on every little pore and it’s good for patients to see their sun damage. But I understand, even when I have used it for myself I start to notice things that I never did before. Patients come in and say I want to look better, but they might not be able to identify what the issue is. When patients see themselves in 3D, they can objectively analyze the skin and the symmetry of the face on a screen. They start to say, “Wow! I didn’t realize I had all of that sun damage, or I didn’t realize my pores were that bad, or that one cheek was higher than the other.” Then you can really start to talk about what to do by prioritizing what bothers you the most and what doesn’t bother you. People come in and they see a menu of things they can do, injectables, lasers, peels, surgery…and they say what is the one thing I can do. And the answer is, there is not one thing to fix everything. So it’s taking this image then having a conversation with the patient about what they want, their budget, timeline, and expectations for recovery, then prioritizing the list with what bothers them most.
How are you currently using 3D imaging in your practice?
There is a full body version which shows breasts, abdomen, buttock, hips, and face, that is what we use. Currently we use it mostly for surgeries like chin or breast implants. A patient can see in 3 dimensions what the actual breast implant to be used will look like in their body at different angles. There is also a table top version which is just for the face.
Can it be use for less invasive treatments as well?
Absolutley! It allows us to examine for asymmetry and simulate the effect of peels, lasers, dermal fillers and other office treatments. The 3D imaging and simulations on the computer screen can give patients a realistic idea of what they can expect from dermal fillers like Juvéderm, or neuromodulators like Botox, or resurfacing treatments like lasers. Repeating the images over time lets us gauge the effectiveness of the treatments. Also, when evaluating a patient’s skin, we can use the results to guide skincare office treatments and home skincare regimens.
Can you walk me through what this process will be like?
The Canfield Vectra does face and body. You stand in front of the machine, and there are 6 high definition cameras at slightly different angles to calculate the image. After we take the photo (which takes about 5 seconds), it pops up on the screen, and builds the face or body in 3 dimensions. The first thing I do is rotate the image so they can see themselves from all different perspectives. Then we assess the face. First in gray mode which allows us to see structure clearly. Then brown mode to show the sun damage and brown spots. Then red, which shows rosacea. Then we can zoom in, to see the pores and texture. Then we look at the face from all different angles. Especially when we are talking about fillers. The one thing with filler, when you look straight on you can’t really appreciate what is needed, but when we look at it from the sides we can see clearly what we call the ogee curve, which is the curve of the cheek. The goal is that inverted triangle of youth so we want to pick up the cheek when it falls. Then we look at symmetry. It takes your face then flips it into two right sides and two left sides, to see the differences. It helps to point out to patients what they need, because they may like one side more then the other. So if they like the fuller side we want to add fillers, or if they want their face thinner you might have surgery or use botox in the jaw to slim the face.
Wow! So if the image shows loss of volume, how would you then proceed?
Fillers do volume. So If we notice loss of volume we can simulate the effect of fillers on the image so you can see how you would look. For the cheeks we would use Juvéderm Voluma. For the the lid cheek juncture, which is right under the eyes, we would use Juvéderm Ultra which is really nice. What happens as people age they start to lose volume in their mid face, it falls down and the bone under the eye becomes more prominent. Ideally you want a soft lid cheek juncture. The Voluma is great when you put it on the bone. So it’s wonderful for cheek enhancement, injectable chin implant, jaw line enhancement, or bridge of nose enhancement.
How about for wrinkles?
For wrinkles the only thing is Botox. There is a wrinkle tool, where I can draw on the wrinkle to soften it so you can see what you would look like with the treatment. Botox is great especially for dynamic wrinkles. It’s good for around the eyes, the forehead, between the brows. or the vertical bands of the neck. Also if people don't like the fullness of their jaw, we can use Botox in the masseter muscle to soften the jawline and thin out the lower face.
But you wouldn't use botox for wrinkles around the mouth, right?
You can’t really. The reason is you don’t want to affect the muscle around the mouth because when you talk or smile it will look very strange.
You said it shows pore size, they get larger as we age don’t they?
Yes, unfortunately they do get bigger. What you can do for that is use lasers like the PicoWay Resolve, old fashioned chemical peels, or skincare products like something with retinol. On the image we can it simulate the effects of resurfacing, taking one layer at a time, showing one treatment or several treatments.
I must admit I am most afraid of seeing my sun damage. My dirty little secret is that I had a period in my teens where baby oil was my sunscreen of choice. So what do you recommend when the 3D image shows signs of sun damage like dark spots?
When we were all kids we used oil, which had no sunscreen at all, and we would just bake in the sun. Now if a parent allowed their children to do that it would be considered child abuse! Luckily we have treatments that can help with the damage done. We recommend laser treatments for sun damage and brown spots. The Clear & Brilliant laser which is mild. If you want more intensive, the PicoWay, or intense pulsed light treatments. The PicoWay is great because you can use it on all skin types and colors and there is minimum downtime. There’s a prescription, that I don’t write for anymore, for hydroquinone. I do recommend SkinMedica Lytera, which is an over the counter skincare product from doctors offices that suppresses the melanin production. They did a head-to-head study of both and the Lytera has better effects, less dryness and rashes.
And if the machine shows rosacea what would you recommend for that? I heard there is a new cream on the market that works well.
Yes, it’s called Rhofade and it just received FDA approval. So that’s exciting. We also have a laser called the Vbeam that helps with vascular issue such as rosacea. So I would recommend a combo of the cream and laser treatment.
When did you starting using 3D imaging in your practice?
We’ve had it for a few years but we were one of the first to adopt it. They keep developing updated software making it better and more powerful. With more advanced software and computer power we can analyze patient’s skin more in depth looking at sun damage, vascular abnormalities, using the 3D views to assess for symmetry, etc. Also we can follow the patients over time to gauge the effects of their treatments on skin texture, pore size and sun damage.
Why is this technique gaining popularity?
I think that the rise of selfies and face tuning allows people to examine themselves in more detail and to be able to see themselves without blemishes, hyperpigmentation and wrinkles. Patients come to the office looking to achieve the same results of photoshop and Instagram filters with fillers, Botox and laser treatments. During the consultation process we can review with the patient what is realistic and then set expectations from their treatments.
So, what’s next?
The latest thing is taking the 3D images and actually printing the before and after with a 3D printer. So a patient could take a 3D printed model of their proposed rhinoplasty or chin implant result and hold it up and see it. Another new technology on the horizon is to take the 3D image and then put it on a Virtual Reality headset and look at the results as if you are looking at your own body.
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