American Association of Plastic Surgeons

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Precision Rhinoplasty Using Virtual Surgical Planning and Departmentally Manufactured, 3D-Printed, Sterilizable, Patient-Specific Anatomic Models
Samantha G. Maliha, B.A.1, Jonathan M. Bekisz, B.A.1, Hannah A. Liss, B.A.2, Lukasz M. Witek, MSci, PhD2, Paulo G. Coelho, D.D.S., PhD2, Roberto L. Flores, MD3.
1New York University School of Medicine, New York, NY, USA, 2New York University College of Dentistry, New York, NY, USA, 3Hansjörg Wyss Department of Plastic Surgery, New York, NY, USA.

PURPOSE: Rhinoplasty is one of the most common and challenging procedures in aesthetic surgery. In order to assist surgeons in operative planning, patient communication, and surgical performance, we developed a protocol for virtual surgical planning and affordable in-house manufacture of 3D-printed rhinoplasty models.
METHODS: 3D photographic preoperative patient images (3dMD, Atlanta, GA) are converted to sterolithography (.stl) files, and uploaded to a freely available 3D imaging platform, BlenderTM (Version 2.78, Amsterdam, The Netherlands). We then perform virtual rhinoplasty for each patient including lowering the dorsum, infracture, columellar lengthening, tip refinement, and alteration of nasal tip projection/rotation. The 3D reconstructions from before and after virtual surgery planning are manufactured in-house by a departmentally-owned 3D printer (Builder Premium 3D Printer) using a polylactic acid filament. Upon completion, these models are sterilized and brought into the operating room.
RESULTS: Ten patients have undergone rhinoplasty using virtual surgical planning and departmentally manufactured, sterilizable, patient-specific 3D printed models of preoperative and planned "postoperative" facial/nasal appearance. Digital models were available to the surgeon preoperatively for review of treatment plan with the patient and confirmation of operative approach. Each model required 4 hours average of digital preparation/sculpting time. Manufacturing averaged 22 hours of 3D printing time. The materials cost of each pair of pre- and post-operative models was $4.00.
CONCLUSION: We present a reproducible protocol for virtual surgical planning and affordable in-house manufacturing of sterilizable, scaled, patient-specific, 3D printed rhinoplasty models to be used in patient education, preoperative planning, and technical execution of this challenging procedure.


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