Open-Source 3D Morphing Software for Facial Plastic Surgery and Facial Landmark Detection Research and Open Access Face Data Set Based on Deep Learning (Artificial Intelligence) Generated Synthetic 3D Models.

Background: The scarcity of 3D facial models presents a significant hurdle for researchers and educators. Gathering such data demands substantial resources. Objective: To introduce an open-source 3D morphing software to generate 3D facial data sets for research and to provide a large sample data set that is based on synthetically generated 3D models. Methods: Software is developed to morph 3D facial models in bulk by altering landmark locations. Twenty synthetic 3D facial models are generated utilizing deep learning tools and 28 landmarks located on each. The measurements of synthetic models are confirmed to be realistic by comparing them with facial statistics. Several facial deformities and types are simulated at various magnitudes on 3D models to generate a large data set. Results: An open-source software and an open-access data set of 980 3D facial models, each with 28 landmark locations, are provided. Since the data set is based on synthetically generated 3D models, no institutional review board approval is required. Conclusion: The 3D morphing software and the large 3D data set are expected to benefit researchers and educators in the field of facial surgery and facial landmark detection.

Three-dimensional (3D) area and volume measurements for rhinoplasty.

BACKGROUND: Morphometric changes achieved in rhinoplasty are mostly analyzed on two-dimensional (2D) images. However, most of these alterations are amenable to three-dimensional (3D) analysis. OBJECTIVES: Objective measurements for rhinoplasty are currently done on 2D photographic analyses. We believe that newer techniques will develop. This is a study to help define new parameters. METHODS: Landmarks that are widely used in the literature were used to define the boundaries of these measurements. They comprised certain parts of the nose (tip, dorsum, radix, etc.). Measurements were done on a generic face (GF) 3D model. The model's nose was then morphed using the free, open-source 3D modeling software (Blender) to generate seven different deformed noses and to perform the area and volume measurements. RESULTS: Each nose with a different type of deformity demonstrated significant area and volume differences. For example, comparing area measurements to GF-Pleasant nose, GF-Snub nose showed a significant difference at the tip (43.3% reduction). Volume measurements were found to be mostly parallel to the area measurements; however, some incongruences were noted. CONCLUSIONS: We show that new area and volume measurements can be reliably developed for 3D-scanned images. These measurements can be utilized and will enrich the facial analysis and evaluation of the outcomes of rhinoplasty.

Facial Surface Anthropometric Features and Measurements With an Emphasis on Rhinoplasty.

BACKGROUND: Facial features and measurements are utilized to analyze patients' faces for various reasons, including surgical planning, scientific communications, patient-surgeon communications, and post-surgery evaluations. OBJECTIVES: There are numerous descriptions regarding these features and measurements scattered throughout the literature, and the authors did not encounter a current compilation of these parameters in the medical literature. METHODS: A narrative literature review of the published medical literature for facial measurements used for facial analysis in rhinoplasty was conducted through the electronic databases MEDLINE/PubMed and Google Scholar, along with a citation search. RESULTS: A total of 61 facial features were identified: 45 points (25 bilateral, 20 unilateral), 5 lines (3 bilateral, 2 unilateral), 8 planes, and 3 areas.A total of 122 measurements were identified: 48 distances (6 bilateral, 42 unilateral), 57 angles (13 bilateral, 44 unilateral), and 17 ratios. Supplemental figures were created to depict all features and measurements utilizing a frontal, lateral, or basal view of the face. CONCLUSIONS: This paper provides the most comprehensive and current compilation of facial measurements to date. The authors believe this compilation will guide further developments (methodologies and software tools) for analyzing nasal structures and assessing the objective outcomes of facial surgeries, in particular rhinoplasty. Moreover, it will improve communication as a reference for facial measurements of facial surface anthropometry, in particular rhinoplasty.

Evaluating the agreement and reliability of a web-based facial analysis tool for rhinoplasty.

PURPOSE: Rhinoplasty is one of the most common and challenging plastic surgery procedures. Facial analysis is a crucial step in planning. Utilizing three-dimensional (3D) model of a patient's face is an emerging way of performing facial analysis. This paper evaluates the agreement and reliability of facial measurements taken using a web app, located at digitized-rhinoplasty.com, that utilizes 3D models of the patient's face. METHODS: Eleven measurements were calculated on 16 human subjects. Three methods of measurements were performed: direct measurements on human subjects' faces, measurements on 2D photographs, and measurements on 3D models of face scans. The Bland-Altman plot is used for testing the agreement between the web app and the well-known Blender 3D modeling software. Intra-rater and inter-rater reliability was calculated and compared for 2D and 3D methods using the intraclass correlation coefficient (ICC) method. The statistical analysis methods were checked for the normality and homoscedasticity assumptions. RESULTS: The results indicate that the web app and Blender software show agreement within 95% confidence limits. The web app performs well in intra-rater and inter-rater reliability statistical analysis. The web app's reliability scores are consistently better than facial analysis software which was found highly reliable in a previous study. We also compare the methods of measurements in terms of time, ease of use, and cost. CONCLUSION: The utilization of 3D computer modeling for facial analysis has its advantages and started to become more common due to recent advances in technology. The web app utilizes 3D face scans for pre-operative planning and post-operative evaluation of facial surgeries. The web app performs well in agreement and inter-/intra-reliability analysis and performs consistently better than software that works utilizing 2D photographs. The web app provides accurate, repeatable, affordable, and fast facial measurements for facial analysis when compared to direct and 2D methods.

Surgical Algorithms in Rhinoplasty: A Scoping Review of the Current Status.

BACKGROUND: Algorithms define a sequence to approaching a subject. This study represents a scoping review seeking to define the role of surgical algorithms in rhinoplasty. METHODS: A scoping review was conducted. Pubmed/MEDLINE, Web of Science, and Google Scholar, as well as a citation searching was performed to find eligible studies for review. Eligibility criteria included studies published in English, human subjects ≥ 15 years old, and all included surgical algorithms were for primary cosmetic rhinoplasty. RESULTS: In total, 514 studies included the key search terms. Thirty-nine studies were evaluated for data extraction. The majority of the algorithms were from USA-based publications (22/39). Flow-chart type algorithm was used in 23 and text-based algorithms in 15 of the 39 studies. Algorithms related to tip shape and/or position were most frequent (19/39), followed by those for crooked nose and dorsal height. Only 7 of the algorithms described outcomes for utilizing the algorithm. CONCLUSIONS: Very few surgical algorithms have been published for cosmetic rhinoplasty. A minority of these studies have published outcomes. This study provides a description and summary of these algorithms and also shows that future studies could be done to further develop surgical algorithms for rhinoplasty and evaluate outcomes. LEVEL OF EVIDENCE III: 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 http://www.springer.com.

Digitizing rhinoplasty: a web application with three-dimensional preoperative evaluation to assist rhinoplasty surgeons with surgical planning.

PURPOSE: Rhinoplasty is one of the most common and challenging plastic surgery procedures. The results of the operation have a significant impact on the facial appearance. The planning is critical for successful rhinoplasty surgery. In this paper, we present a web application designed for preoperative rhinoplasty surgery planning. METHODS: The application uses the three-dimensional (3D) model of a patient's face and facilitates marking of an extensive number of facial features and auto-calculation of facial measurements to develop a numerical plan of the surgery. The web application includes definitions, illustrations, and formulas to describe the features and measurements. In addition to the existing measurements, the user can calculate the distance between any two points, the angle between any three points, and the ratio of any two distances. We conducted a survey among experienced rhinoplasty surgeons to get feedback about the web application and to understand their attitude toward utilizing 3D models for preoperative planning. RESULTS: The web application can be accessed and used through any web browser at digitized-rhinoplasty.com. The web application was utilized in our tests and also by the survey participants. The users successfully marked the facial features on the 3D models and reviewed the auto-calculated measurements. The survey results show that the experienced surgeons who tried the web application found it useful for preoperative planning and they also think that utilizing 3D models is beneficial. CONCLUSIONS: The web application introduced in this paper helps analyzing the patient's face in details utilizing 3D models and provides numeric outputs to be used in the rhinoplasty operation planning. The experienced rhinoplasty surgeons that participated to our survey agree that the web app would be a beneficial tool for rhinoplasty surgeons. We aim to further improve the web application with more functionality to help surgeons for preoperative planning of rhinoplasty.

Mobile technology for recording surgical procedures.

Mobile technology has been advancing in countless directions, and in particular medicine has been an attractive place for mobile technology innovators. The recording of surgical procedures, however, has not been one of those directions, possibly because there is a lack of software specifically designed for recording open surgical procedures. Using an iPhone SE as the device to record video along with an app devised by one of the authors, five cases of various neck surgeries (two submandibular gland resections, two neck dissections, one neck dissection and supraglottic laryngectomy) were recorded. The authors were able to completely record four out of the five cases. One case was not recorded due to storage insufficiency on the device. The recorded images were evaluated by a jury comprised of three people, and according to their findings the image quality was of an acceptable level. The authors conclude that, with a specifically devised app and a smartphone with sufficient storage capacity, surgical video recordings are possible. Specific precautions will need to be taken to ensure the privacy of these medical records. Once that is done, it is possible to use a smartphone to provide a convenient and affordable way of recording surgical procedures.