The technology of computer imaging as a clinical tool to enhance communication between a plastic surgeon and his patients became commercially available in the early to mid 1990s.

Dr. Terino was a pioneer in acquiring this technology at that time even though it was then extremely expensive. He has an 18-year history of applying this tool to his thousands of patient consultations in his effort to ensure that both he and the patient are communicating closely on the same page about the patient’s wants, needs, and desires and especially regarding the reality of achieving their expectations as well as explaining throughly to patients the reality of the potential downside of the procedures including adverse situations which may occur and their subsequent resolution.

The major company which developed and designed this tool is the Canfield Imaging Company. The technology application program is called Mirror Image. Utilizing this tool on every patient, Dr. Terino first records five or six different views of their face or figure into a camera which transfers them into his special computer which is not connected in any way to the internet or other computesr for total patient security reasons. This computer archives them by alphabetical listing and affords patients listing and easy retrievability.

Each patient must sign a detail photographic permission in which they specify whether or not they will allow their before and after photos to be used for scientific research purposes versus marketing public relation purposes versus kept entirely private without anyone looking at them.

It is very rare that a patient will object to having their photos used to help other patients either publicly, in the office, in scientific textbooks, or even for advertising purposes.

The use of their photographs has totally revolutionized Dr. Terino’s cosmetic consultations

1. The doctor can examine the patient objectively in different poses
2. The patient can see themselves more objectively in a way which they may not appreciate since nearly everyone is unhappy with an objective viewing of themselves photographically or on videos.

This allows both patient and doctor to isolate various specific points and areas that they can talk about so the patient can explain to the doctor if or what they wish to change and to what degree.

Dr. Terino is able with a mouse cursor to make quick alterations of the parts of the face that the patient is requesting to change. He then makes several more different changes than the first one for comparison purposes.

These are then placed side by side with the patient’s original present time photos to allow the patient and the doctor to assess the appropriateness of the change to determine whether it is exactly what the patient would like or needs more artistic alteration.

Prior to this technology, plastic surgeons could only talk to patients and listen to verbal explanations. Their only tool was a possible on-the-spot Polaroid camera until digital cameras were afforable. Then it required some effort to place the pictures from a digital camera into a specific computer location and file for each patient.

The doctor could only hope that he could draw on the Polaroid picture in a way that would be acceptable to the patient. A mirror was also used to hold in front of the patient while either the patient or the doctor manually shifted the position of the tissues on the face to somehow try to imitate the surgical change.

The entire process was cumbersome, grossly imprecise, and could not give patients what they wanted- a reasonable image of their changed “self” that they could use to help make their decision of what they would be satisfied with.

When Dr. Terino first acquired the mirror image program, he too as with many other colleagues, was afraid that the images he produced would not be able to be accomplished with surgery and therefore the patient’s satisfaction would be severely compromised by not achieving what they desired.

He quickly found that when the best modifications he could make of the patient’s image with the computer were compared to their surgery one year postoperatively the images were not nearly as successful as his surgery. He factually reproduces that conclusion over and over again to demonstrate to doctors who he teaches and to patients that his surgery results are far better than his computer images!!

Another invaluable function of the computer is to acquire postoperative photographs in almost perfect position as the preoperative photos that can be compared side-to-side and week-to-week after the surgery so the patient can see and enjoy his own healing process.

After surgeries, there is a considerable swelling, possible bruising, and the volume and shape of the face is temporarily very much altered in an unpleasant way as shown by the camera.

There is also a time when the patients feel that nothing has been changed or the change is not as close to what they wanted and discussed with the doctor. The computer images postoperatively are accurately real and allow the patient and the surgeon to once again communicate very openly and agreeably. Of course Dr. Terino notes the patient’s comments as well as his own into his records on each visit and reads them to the patient on subsequent visits to verify their accuracy.

Dr. Terino has lectured on many occasions to small or large groups of plastic surgeons and seminars and conventions about what he feels makes the use of computer imaging for aesthetic cosmetic surgery, particularly of the face indispensable in today’s technological world.

He feels that high degree of the success of his practice and his results are due over the past 18 years with his decision to employing the exciting artistry of computer imaging into his practice.  

At the present time there are very few plastic surgeons who have been using computer imaging. It requires training to learn and a much longer time with a patient, on average 1 to 1.5 hours to find out what you can look like for the rest of your life!

Now, however, the younger generation of plastic surgeons appears to be paying more attention to this indispensable, invaluable tool used by Dr. Terino for 25 years. One should request as to whether the doctor whom they are going to consult with uses this technology as part of his consultation.

Edward O. Terino, M.D.


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