Dana Barr was injured in a car accident last October, leaving her with a large, unsightly bump on her nose and a deviated septum, damaged cartilage obstructing her nasal passages.
Dr. Jeffrey Hausfeld, a board-certified facial plastic and reconstructive surgeon, told Barr, 17, that the external bump and internal blockage easily could be fixed.
"By late April or early May I still was considering whether or not to have the surgery," says Barr, a Rockville resident, "but I couldn't make up my mind.
"I was really afraid that I wouldn't like the nose that would happen after the surgery. I thought, 'Boy, I could stick with the same nose if the new one would be worse than what I look like now. I might be better off with the one that I have."
About a month later, Barr was sporting a "new" streamlined nose. "I think what really did it was after I saw the computer imaging," she says, referring to Hausfeld's computerized graphics system, an innovative application of a high-definition imaging system developed by AT&T and distributed by Fortune Technologies Ltd. of Falls Church. The system allows the surgeon and patient to see how a specific plastic surgery operation might turn out.
Hausfeld says it serves best "as a communication tool" between patient and surgeon. It gives the patient a clear idea of what the surgeon considers esthetically pleasing and possible for a particular patient, and vice versa. "Basically, we're able to see if we are on the same wavelength. The patient's mental image of the potential result isn't always the same as the surgeon's."
The imaging systems (AT&T's is one of a handful to have hit the market in the last several months) are in limited use but are beginning to crop up in more and more surgeons' offices around the country (at a cost running from $15,000 to more than $30,000).
Their increased use is the latest trend in what has become one of the fastest growing medical specialties: cosmetic surgery. A survey by the American Society of Plastic and Reconstructive Surgeons (ASPRS) indicates that the number of esthetic, or cosmetic, plastic surgical procedures being done has increased by more than 60 percent since 1981 and continues to grow at a remarkable rate.
Hausfeld's imaging system is comprised of a videocamera, a display screen, a computer, appropriate software, a graphics tablet and an electronic stylus, or pencil. The extremely high resolution system (it displays in excess of 250,000 dots) is sharp and very true to color (it displays more than 36,000 different shades of color).
The camera projects the patient's image onto half the screen and freezes it there after flopping a mirror image onto the other half.
The surgeon then uses the electronic stylus to alter the patient's profile -- removing wrinkles, resculpting the nose, lifting the face, adding to the chin -- giving the patient an idea of what the surgery would accomplish.
Hausfeld stresses that he does not give the patient a printout of the computer image and that he warns them not to expect their surgery to turn out exactly the way it appears in the enhanced image.
Plastic surgery is inexact, he says, in that the surgeon is dealing with human tissue as well as variable healing properties. Rather than guaranteeing how the patient will look after surgery, the computer system "sets goals for the surgeon and the patient on what the anticipated results will be."
Where patients in the past had to rely on sketches or showing surgeons photos of other people's features they would like to have, they now can have a clearer picture of what is possible and how their appearance will change.
It is unlikely, says Hausfeld, that a surgeon would use the system to mislead a potential patient: "This system is not a gimmick. The surgeon's reputation depends on what he delivers in the operating room, not on what he can turn out on the computer screen. If he promises something he can't deliver, well, that would be self-defeating, wouldn't it?"
But too high a reliance on visual aids can be a problem, says Dr. Mary McGrath, a board-certified plastic and reconstructive surgeon who also teaches at George Washington University's School of Medicine. With breast implants, for example, "the size might be accurate but the final look may not be the same."
McGrath says her procedure with prospective candidates for breast-augmentation surgery is "talk frankly, look at before and after pictures from other procedures, and have thorough verbal communication."
Richard Fortune, whose Fortune Technologies handles national sales of the AT&T imaging system, says while older surgeons may not take to the imaging systems, they are the coming thing. "We've had a number of inquiries from teaching institutions, and I predict that the next generation of plastic and reconstructive surgeons will use computer imaging the way they do a scalpel. It'll be accepted and expected as a commonplace surgeon's tool."
Commonplace tool or not, the number of people undergoing cosmetic plastic surgery in the United States is skyrocketing, with an accompanying increase in the number of physicians seeking board certification as plastic and reconstructive surgeons. A 1985 ASPRS study indicated, for example, that its 2,700 member surgeons performed more than 477,000 cosmetic surgical procedures, up 60 percent over the 296,500 procedures done in 1981. The number of member surgeons, says ASPRS, is growing by about 10 percent a year.
A couple of statistics some may find surprising: An increasing number of men are electing to have cosmetic surgery, and more and more young women are having breast implants. Surgeons say there are good explanations for both.
"Some men in their fifties," suggests Hausfeld, "are feeling threatened by the baby boomers making their way up the corporate ladder. They come in for rhinoplasty nose resculpturing , chin implants or face lifts, or a combination of procedures. They look younger, feel better about themselves, and their productivity goes up. The psychological impact of such procedures is enormous."
Contrary to what some people might like to think, women opting for breast implants, says McGrath, mostly are not doing it for "secondary gratification" -- in other words, to make themselves more appealing to men. "They are doing it," she suggests, "for self-enhancement."
McGrath says that there is an average profile of the woman having breast augmentation surgery: She is 30-32 years old, college-educated, married and the mother of two children.
"These women," notes McGrath, "voice their interest in having this procedure in terms of their small breasts making them feel less feminine, opting for breast augmentation to increase their sense of femininity, their womanliness."
"The trend in cosmetic surgery," says Hausfeld, "is toward the natural look. We aren't trying to turn the patient into another person. The goal is to, in a sense, make them look more like themselves. Making them look better on the outside can make such a tremendous difference about how they feel about themselves on the inside."
Says McGrath, "They might look 4 or 5 years younger. What others are more likely to see in them is more a picture of vitality and good health."
Friends and family, are likely to react with a "Have you been on vacation? You look so rested."
"All I know," says Dana Barr, "is I was so self-conscious -- even before the accident. I always had sort of a ski-slope nose. It was big and ugly, and the accident just made it worse. Now I feel really different about myself. I even make sure people see my profile now."