A Picture is Worth More Than 1000 Words: How Advanced Imaging Is Improving Plastic Surgery and Aesthetic Medicine w/ Doug Canfield

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Welcome to another episode of
Park Avenue Plastic Surgery Class,

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the podcast where we explore controversies
and breaking issues in plastic

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surgery. I'm your co-host, Doreen Wu.

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I'm excited to be here with Dr. Lawrence
Bass, Park Avenue plastic surgeon,

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educator, and technology innovator, as
well as our special guest, Doug Canfield,

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president of Canfield Scientific
in Parsiphony, New Jersey.

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The title of today's episode is A Picture
is Worth More Than a Thousand Words:

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How Advanced Imaging Is Improving
Plastic Surgery and Aesthetic Medicine.

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We often start our episodes with
a little history. So, Dr. Bass,

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what has the role of photography
been in plastic surgery?

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Photography is really central
to documentation in plastic

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surgery, and it always has been.

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So this is very much like
an orthopedic surgeon.

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The only way they can really map
what they've accomplished is by using

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x-rays to see what happened to the
bone before and after procedure,

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because what we do in plastic surgery
is visible on the surface of the body.

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Photographic images of the
patient before and after

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procedures is again central
to that documentation.

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And it's so central that in fact,

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the first episode of
this podcast discussed

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before and after images and
photography standardization.

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That being said

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without that documentation,

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we really have trouble assessing results
because we can't really remember what

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it looked like before.
We think we remember,

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but we don't,

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our image of what we look like is
probably fixed how we looked in our late

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twenties. And so we don't realize
what that feature was like.

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And once you go and do a procedure,
spend money go through recovery,

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then you start looking at everything
very carefully and you start picking out

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features that were present before, but
you didn't even realize were there.

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And so the only way to be real
about what's happening is to have

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really good quality
imaging before and after.

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Where has photography gone from there?

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Well, you know, when I first
started working in plastic surgery,

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which is round about 30 years ago,

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that was done with film.

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So we walked around with our camera
bag and some rolls of film and

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everything was taken on film. Now, of
course, photography is all digital,

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and that changed a lot of things.

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But images are digitally
obtained and stored.

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They're presented on computer screens
rather than printed out in paper

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photographs.

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And there's now three-dimensional

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photography and there's simulation of

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two-dimensional images and
three-dimensional images.

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And so this is a lot like
Photoshop except much more

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sophisticated and specifically
designed and validated for

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medical use. And for that reason,

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we've brought Doug Canfield,

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who's the president of Canfield
Scientific to speak with us today

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because Canfield Scientific is
the leading company and really the

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pioneer in digital photography
for plastic surgery.

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And now host of advanced

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solutions that we're going to discuss
in a little more detail for the

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remainder of this episode.

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Going back to Dr. Bass's answer, we're
gonna take these one at a time. So Doug,

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what are some of the
advances in 2D photography?

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So, thanks, Doreen. You know,

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I think cameras digital cameras and
lighting systems continue to improve,

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but the real advances have been
in the software and those advances

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have allowed the clinical
practices to take more

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standardized, higher quality
before and after pictures,

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so that you really do have confidence in,

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in looking at your before and after
photos and knowing that it's real change,

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true clinical change, and not
some photographic artifact.

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And what about 3D photography? How is
that different from 2D photography?

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What does it show that 2D photos cannot?

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Yeah,

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so stereo photogrammetry is
actually a series of 2D views that

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are put together by an algorithm
with lots of math and with these

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calibrated images to build
a very accurate 3D model.

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And if you think about a 3D avatar
of yourself that's very accurate,

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it allows for measurements to
be made and allows for alignment

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between both pre-procedure and
post-procedure to be matched.

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So you're really looking at
the actual changes over time,

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and you can make area measurements
and volumetric analysis.

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You can even do dynamic capture and look
at things like skin stretch and skin

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elasticity. So lots of opportunity
for making objective measurements in

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addition to the qualitative views
that you get with 2D images.

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You know, this has always been the
challenge in aesthetic plastic surgery.

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A lot of what we look at is
objective in terms of beauty and

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appearance, and the ability to create
an objective measurement of change

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is really meaningful and really helpful.

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Exactly. And how has this changed
the experience for the patients?

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So, you know,

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I think first for patients to be
able to see their before and after

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pictures,

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it allows them to have confidence in
the treatment or procedure that's been

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done.

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But you can also think about using
that pre-treatment photograph as

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a communication tool.

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And instead of looking at before and after
pictures of a different patient and a

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different outcome,

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you can personalize it and think of it
as looking at your after before surgery.

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So this allows the clinician
to work with the image

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and communicate with their patient what
they believe is possible and appropriate

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for them. And this type
of computer simulation,

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both with 2D and 3D,

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has really advanced in
the recent years to be

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very realistic and appropriate for the
types of procedures that are being done.

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Dr. Bass, what does all this
mean for the plastic surgeon?

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Well,

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it gives us an extremely
powerful tool to show the

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patient clearly things we would
have to explain in words or

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sometimes in diagrams.

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And this is critical both to
precision diagnosis and also to

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treatment planning.

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We can show the findings and
features that we're seeing on exam,

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and we always see some additional
things in the images that we don't

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see when we look right at
the patient in the exam room.

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We can simulate how the appearance
would likely change with various

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interventions so the patient can
gauge the importance to them and their

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individual aesthetic goals.

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And that's an important thing
because often a patient will

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explain what they want and they
have one mental image in their

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mind, and I have a different mental image,

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and that's not going to work well at
getting them the result they want.

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But if we're both looking at the
same simulation and they say, "yeah,

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that's a good size for me
with breast augmentation," or

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"that's the amount of reduction on the
bump on my nose that I want or the amount

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of upturning of my nose that I

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want." I walk in the operating room with
the exact same picture in my head as

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the patient has, we're more likely to get

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precisely to the result that the patient
is hoping for than if I walk in with

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one mental image and they have something
different. In addition to that,

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as Doug mentioned,

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we can show changes in before and
after images with these advanced

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analysis tools that can show
contour changes like volume loss

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after liposuction or breast
reduction or volume medician

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like with a breast augmentation
or when we do fat grafting or

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filler injections.

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And these systems can map
out exactly where and to

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what degree the surface contour
has been changed, which is really,

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really elegant and really evocative
for patients to understand

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what's going on.

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There are other tools that can
look at skin smoothness or color

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evenness, things like that
that can be analyzed as well.

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And a final thing for me is,

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and I thought it was interesting
the way Doug described it,

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that a 3D image is really
a series of 2D images that,

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that are being combined.

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But if I just have my six or
eight standard 2D images that I

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take into the operating room,

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like in the old days when they
were actually prints that's

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different.

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I can take the 3D image and
rotate it on the video screen in

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the operating room,

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and see any aspect of the
patient appearance that might

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come up during the
course of the procedure.

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And that's far superior to what we
got with just a few static images

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like in the old days.

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Are there any other ways advanced
imaging is helping the plastic surgeon?

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Well, you know, I love to do research,

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and photographic research
tools help study,

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evaluate, and improve new
treatments and procedures.

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Tell me, Doug,

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what role does Canfield Scientific
play in performing research in plastic

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surgery, dermatology, anesthetic medicine?

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Thank you, Doreen.

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Canfield provides
photographic documentation

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services to companies that
are studying new products

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and devices for approval
with the FDA. And in fact,

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I started the company
offering standardized
photographic documentation for

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facial imaging,

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and it was looking at topical
retinoids for sun damage

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and think about products like
retin-A today that were approved.

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They were approved partially
based on high quality

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registered standardized before and after
pictures. And today that's evolved.

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And in the aesthetic space,

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we not only work in skin
rejuvenation and making claims

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there, but also injectables like
toxins and fillers body contouring

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procedures and injectables for body
contouring injectables for cellulite.

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All of these things can be
documented in a very reliable,

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consistent way with 2D images.

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And some of them are really
appropriate for 3D imaging as well.

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So we can look at durability of volume,

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let's say in a mid-face volume study.

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So we can know how long will
that volume last in a phase.

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And by having a calibrated 3D image,

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we can actually see you know, the,

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the durability of the product.

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So it really gives us a
much better understanding

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in reviewing some of the
efficacy of these different

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products and treatments.

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And I think this is critical,
both for, of course,

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regulatory approval, which we
need to have the product at all,

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but also for the clinicians
to understand objectively

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in a quantitative data driven way,

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what nowadays we call
evidence-based medicine what the

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performance of these different
treatments and products are.

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And that helps us relate
that same information to our

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patients. So Doug,

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we always like to talk about
the future and what's coming.

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Of course none of us have a
crystal ball and can guarantee,

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but someone at the cutting edge of this

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field like yourself
probably has some notion of

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where things are really changing and
where we're going to see exciting new

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developments. So what do you
think the future of imaging is,

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let's say 10 years down the line?

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Already we're seeing, I think,

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evidence of how AI can help.

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So artificial intelligence
is around us everywhere,

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and it's certainly around us
with our digital images as well.

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So today we're introducing
first impression software,

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which allows a patient
or a surgeon to pick

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the trait that they want to most improve.

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And then using very
large annotated data sets

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of different faces,
being able to model that,

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how you can improve that first impression.

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So you want to look
less tired that may show

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that you need to add a little filler in
the Infraorbital Hollow below the eye or

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might skin resurfacing these
little procedures that can add

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up. And it's a very
powerful communication tool.

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So we're seeing AI in that space.

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We're seeing AI in the diagnostic
support space coming through.

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So we're actually going
to see clear devices

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that are used by clinicians
to make early diagnosis of

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things like skin cancer. And that's all
in the frontier and happening today.

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And I'm pretty sure in 10 years
time we're gonna see a lot

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of different methods approved
methods by the FDA of

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using imaging as a class two and maybe
even a class three medical device.

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That's really interesting. And I think
just so our listeners can understand,

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when you say a large annotated database,

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how many entries are you talking about?

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Just to give people a sense.

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Usually data scientists talk
in terms of tens of thousands.

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For many of our skin cancer
modeling databases we have

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over a hundred thousand annotated
images. Some have millions.

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And of course the quality of the
data sets are really important.

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And they are annotated.

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So somebody a human is actually
deciding what is in these

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images and teaching the computer
then how to interpret this data,

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and that's the part that just
keeps getting better and better.

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So this sounds like a tremendous
amount of hard work and

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a lot of lead time to get
these things to a usable

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state with a lot of very
smart people working on it.

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Absolutely. These aren't easy things,

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but I think they're going to be important
for the future of imaging and how it

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can bring value to both
patients and to surgeons and and

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practitioners.

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That is truly fascinating. And
lastly, before we wrap up the episode,

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Dr. Bass, do you have any
takeaways for our listeners?

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As we said at the beginning,

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photography has always been central
to assessing our results in plastic

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surgery.

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And these advanced imaging
technologies have just taken

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that to a whole other level and made the

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utilization of images, and after
all this is plastic surgery,

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how things look is what it's all about,

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so it's made it even more central to

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the consultation, to
the treatment planning,

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to the execution of the treatment
and the assessment of the results.

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So with that,

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I'll thank Doug for joining us from
Canfield Scientific and sharing

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his expertise on what's happening
in this field of advanced

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imaging in plastic surgery,
dermatology, and aesthetic medicine.

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It's really been a pleasure and I echo

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Doreen's comment that this area
is truly fascinating and exciting

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and we're looking forward to
all the new tools that your

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company is going to put into our hands.

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Thank you Dr. Bass. And thank you Doreen.

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This podcast has been a lot of fun and
it's been fun to reminisce about 35

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millimeter film and what
we're doing today with AI.

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And I do believe in the future
we will be able to use these

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trained data sets to be useful,

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clinically useful for both the patient
and the clinician to be able to provide

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and learn what is possible
with patient procedures.

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Thank you Doug, again,

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for taking the time to share your insight
and expertise with us and illuminating

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us with what's to come.

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And thank you to our listeners for joining
us today to hear about the important

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role photography and advanced
imaging in aesthetic medicine.

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I hope you found this episode as
fascinating and informative as I did.

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If you think of other exciting
developments or trends
in plastic surgery that

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you would like us to discuss
in upcoming episodes,

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00:18:01,721 --> 00:18:04,840
please reach out by email or
Instagram. We'll see you next time.

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This is Doreen Wu thanking
you for joining Dr. Bass,

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Mr. Doug Canfield of Canfield Scientific,

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and me for this riveting
discussion of photography,

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advanced imaging and plastic surgery.

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Be sure to tune in next time and don't
forget to subscribe to our podcast to

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00:18:20,051 --> 00:18:23,050
stay up to date with all of the exciting
content that is coming your way.

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Thank you for joining us in this episode
of the Park Avenue Plastic Surgery

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Class podcast with Dr. Lawrence
Bass, Park Avenue plastic surgeon,

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educator, and technology innovator.

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The commentary in this
podcast represents opinion.

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This podcast does not
present medical advice,

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but rather general information about
plastic surgery that does not necessarily

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relate to the specific conditions
of any individual patient.

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No doctor patient relationship
is established by listening
to or participating

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00:18:54,131 --> 00:18:54,964
in this podcast.

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Consult your physician to advise you
about your individual healthcare.

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If you enjoyed this episode,

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00:19:01,040 --> 00:19:05,250
please share it with your friends and
be sure to subscribe to our podcast on

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00:19:05,251 --> 00:19:09,090
Apple Podcasts, Google, Spotify, Stitcher,

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00:19:09,260 --> 00:19:11,850
or wherever you listen to podcasts.