Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: TUESDAY, June 15, 1993 TAG: 9308250306
SECTION: EXTRA PAGE: 1 EDITION: METRO
SOURCE: ALMENA HUGHES STAFF WRITER
DATELINE: LENGTH: Long
Earlier in the week, I'd wielded a computer's "pencil" to help a dentist pick his teeth. And the week before that, in plain sight of passersby at Leggett in Tanglewood Mall, I'd had my hair colored ecru and crew cut - all within the safe confines of the computer screen.
Computer-imaging technology shows possible alterations in a person's appearance without the person actually undergoing the changes. So now, picking in public is not only permitted, it's prudent.
After all, cosmetic dentistry or plastic surgery can run into hundreds and even thousands of dollars. And how can you put a price on evading bad hair?
"A major advantage of imaging is that it gives a visual reference that helps clarify expectations," says Roanoke plastic surgeon Enrique Silberblatt. "It helps both the patient and me get a clear idea of what we're aiming for. And with the imaging, people seem to have a better, more realistic sense of what the outcome will be, so they are not disappointed."
As far as he knows, Silberblatt is the only plastic surgeon in Southwest Virginia using computer-imaging technology. He says he thinks a surgeon in Lynchburg also uses it.
Silberblatt says he installed his $20,000 AST computer system shortly after opening his practice in 1988 to enhance consultations rather than as a selling gimmick. Because he doesn't advertise the system's availability, most of his patients hear about it through word-of-mouth.
Imaging can give them an idea of what to expect, Silberblatt says. But he emphasizes that it cannot guarantee what is to come.
"The fact that the image is two-dimensional while a face is three-dimensional immediately poses some limits," says dentist David E. Black, who has been using his $15,000 (on special) NuImage computer system at his Vinton office for about two and a half years.
Black says he thinks he's the only dentist in the Roanoke Valley using the technology. He sees it as an asset to his practice and to communication with his patients, and he advertises its availability.
"Dentistry carries enough apprehensions without being apprehensive about what it will look like," Black says.
He, too, is careful to emphasize that the image is only a simulation - close to, but not necessarily identical to the finished product.
Neither Silberblatt nor Black charges for imaging when it is done as part of a regular consultation. But to image someone who is just curious, Black charges $50.
Leggett's Ultima II hair imaging promotion, which it began last year, costs $25. The imaging session includes a makeover with lots of personalized makeup tips and a customized makeup chart, as well as a selection of 10 hairstyle possibilities. The fee can be applied to the purchase of Ultima II products.
Each of the three sessions lasted 30 minutes to an hour and basically worked the same: A computer-generated photograph was taken to serve as the permanent basis for the imaging. Then, using an electronic pencil and sketch pad - similar to an Etch-A-Sketch - plus commands in the computer program's menu, the computer operator changed specific parts of the image - hair, teeth, chin, nose - until the desired effect was achieved.
A print of before-and-after photos then was made. Ultima II gives the print to the customer. The doctors usually place the print in the patient's medical records file.
For my meeting with Silberblatt, I brought along a picture of singer Janet Jackson, whose nose I'd selected. I asked the doctor to make her nose mine - hypothetically.
Using the picture as a guideline, computer-imaging consultant Cindy Sheppard, who operates Silberblatt's computer, took front and side-view computer photos of me, then manipulated the images to narrow my nostrils, reduce my bridge and tilt the tip of my nose slightly upward. The finished product looked more like a smaller version of my own nose than Jackson's.
At my request, Sheppard also firmed under my jaw line and slightly elongated my chin.
During the entire procedure Silberblatt explained what would be required surgically to achieve what I was seeing on the screen. My nose would require adjusting some cartilage; my chin would require a small prosthetic addition; my jaw could be done with liposuction. The result, which Silberblatt said would probably cost about $7,000 and take about four hours to perform, was a decidedly more youthful though not dramatically different profile.
Both Silberblatt and Black said the idea of most procedures is to look better, though it should not be obvious why.
Silberblatt also said it would be unlikely for him to actually perform all the surgeries he'd demonstrated on the computer on one patient. "I'd probably encourage you to just do the jaw and see if that didn't have the desired result, without adding to your chin. I try to get the most effect for the least amount of money and surgical risk," he said.
Both doctors said that imaging cannot be used for all procedures. For example, Silberblatt won't try to image a facelift because the computer can only erase shadows, which is not a good simulation of what actually goes into removing wrinkles.
Black, who has practiced dentistry in the Roanoke Valley for 22 years, says imaging also can't interpret some side effects of procedures, like the widening of a person's face that might occur with the addition of teeth. "That's just something that the dentist would have to anticipate from experience because the computer would not automatically show that," he says.
In some cases, previews have sent people in the opposite direction from the one they had originally intended. Black recalls a patient who thought he wanted to close the gap between his teeth through bonding. However, after a preview, he decided instead to get braces and have the teeth physically realigned. Silberblatt recalls a patient who thought her nose was too large but after a consultation decided instead that her chin was too small.
"Concepts of beauty vary from culture to culture," Silberblatt says. "I'm not here to impose my standard of beauty on someone else. By doing the imaging I can get an idea of what we're aiming for. And it may turn out that I can suggest something more simple that will still get the desired result."
Most of the doctors' requests are for elective surgeries, which are not usually covered by insurance. Black said most of his patients want to preview space adjustments or changes in the color or shapes of their teeth. Most of Silberblatt's previews are for nose or chin work, although he also uses imaging for breast augmentations or contouring thighs.
Silberblatt said that nationally, more sophisticated imaging systems are being used to overlay X-ray or head scan data on three-dimensional models of a patient's skull for correcting facial defects; to make custom-fitted implants that can easily be placed during surgery; and to create difficult prosthetics, such as a missing ear, by creating a mirror image of the one remaining.
So now here I sit, staring at about 20 computer-generated possibilties and pulling my hair with indecision over which look is best. At this rate, maybe I should have had one imaged as bald.
by CNB