Microsoft describes its HoloLens technology as the first self-contained, holographic computer that allows you to not just engage with digital content but to interact with holograms. Could it be the next step to achieving cosmetic results that more closely align with patient expectations? Plastic surgeon Philip Miller, M.D., thinks so. He’s a pioneer in bringing the mixed reality technology into the cosmetic surgery practice.
“The idea is to take a patient’s three-dimensional hologram and then use that hologram during surgery to overlay it over the patient’s face as opposed to eyeballing a picture,” says Dr. Miller, a partner at Gotham Plastic Surgery, with locations in New York City and Los Angeles. “We are actually taking the image that we have created in 3D space and creating a hologram from it. Then, in augmented reality, we apply that hologram on the patient’s face.”
HoloLens has been commercially available the last three years, used primarily for corporate and industrial applications.
Dr. Miller started using the holographic technology about a year ago. To date, he has used HoloLens with a handful of rhinoplasty patients.
“You can see the world through the visor,” Dr. Miller tells The Aesthetic Channel. “You can also control holograms, which are objects that will appear in your view, as if they are part of the environment.”
How HoloLens Works
First, a patient’s photograph is obtained and processed to render a 3D image of that patient’s face, which is then transferred to a computer. “The Canfield Vectra imaging system has the capacity to take three stereoscopic photographs and stitch them together to create a single 3D image of an individual’s face,” Dr. Miller explains. “That image is then manipulated and modified to resemble what the patient would like to look like postoperatively.”
However, instead of printing the image hardcopy or having the image reside on a computer in the treatment room, the file of the converted 3D image is uploaded into HoloLens. “You can then open that file in HoloLens and see that person’s face in 3D right next to the patient in the operating room,” says Dr. Miller, a rhinoplasty specialist. “You can also actually glide the image of the face on top of the patient’s real face.”
As a result, Dr. Miller is able to precisely assess whether or not what he has discussed with the patient beforehand is now on the table, taking into account the typical swelling associated with the procedure.
“It is fairly routine, nowadays, for doctors to use some type of software to morph their patients’ photographs to provide guidance as to the patient’s intended, desired results,” Dr. Miller says. “These two-dimensional photographs in up to three different views are printed and available during surgery.”
In contrast, HoloLens is 3D, augmented reality that detects hand motion. Touching air and raising up and down the palms of the hand or fingers are among the funky maneuvers performed by Dr. Miller during surgery. “To everyone else, it appears I am acting randomly. But to me, I am actually manipulating controls that only I can see in front of me to move that hologram, which again only I can see,” he says. “With hand motions, I can twist, turn or enlarge the hologram.”
Learning Curve and Protocols
The retail price of HoloLens is approximately $3,000, according to Dr. Miller. “At this point, it is for early adopters of technology who know how to manipulate it,” he says. “HoloLens is as complicated as simple morphing is now, while at the same time as complicated as morphing was 30 years ago. I believe the millennials will be able to embrace this technology pretty quickly. The learning curve is not steep; it is gradual, depending on one’s background.”
Dr. Miller says currently there is no standard protocol to learn how to effectively use HoloLens. “There is no turnkey solution,” he states. “You need to become proficient in understanding how your hand interacts with the device.”
While, he doesn’t believe there are downsides to the technology, Dr. Miller does admit, “The biggest roadblock is the technical capabilities of the end user.”
Dr. Miller predicts there will be amazing applications of HoloLens in the future, such as an analysis of a patient’s face to suggest specific points for Botox injection and in how many units.
As for patient feedback, “They just want great outcomes. They don’t care how they are achieved,” Dr. Miller says. “Patients are happy with HoloLens. In fact, I have seen a 25% increase in patient satisfaction. Plus, when I tell them what I will be doing, they find it absolutely fascinating and the coolest thing in the world. Independent of that, I feel I am attaining greater precision with HoloLens.”
Some of Dr. Miller’s patients also specially request 3D imaging. “Using HoloLens lessens patient anxiety because patients see in advance the 3D images in their entirety and know the images will be overlaid over them during surgery for better results,” he says.