VSP versus MirrorMe3D

You do VSP. Do you need MirrorMe too? Let's take a look together at the benefits of creating custom plans for aesthetic results in reconstructive procedures.

We get this question quite often so let’s explore the difference between VSP (or similar services) and MirrorMe and why both are important to saving time in the operating room and increasing patient satisfaction in a value-based care setting.

What is VSP?

We get this question quite often so let’s explore the difference between VSP (or similar services) and MirrorMe. 

A quick primer on VSP, also known as virtual surgical planning: VSP was popularized by Medical Modeling, and helps surgeons planning orthognathic, craniofacial, maxillofacial, and other head and neck procedures. Surgeons submit CT (or other DICOM data) to trained biomedical engineers and complete a planning session, usually through a web meeting, to visualize possible changes to different areas to the skull, depending on the procedure the patient is undergoing.

VSP vs. MirrorMe

The most obvious difference between VSP–that is, virtual surgical planning–and MirrorMe is that we focus on soft tissue planning and honing in on aesthetic changes which may or may not be a result of planned bony changes. 

For example, if a patient needs or desires custom cheek implants, you may think to schedule a VSP session to design the cheek implants. VSP is great for studying the CT of the patient and determining size and shape within the context of the CT.  

However, what about the soft tissue volume on the patient? Or, if the patient is asymmetrical in cheek volume from one side to the other? Also, what about the effects of liposuction or facial fat grafting plus implants? And what if the implant profile is 5mm in projection? Will the patient see a full 5mm change postoperatively?

Visualizing aesthetic changes

These are all good questions that we’re regularly helping surgeons with visualizing. Especially for soft tissue and aesthetic outcomes, these small details can be quite important to the overall result for your patient. 

Working with surgeons, we’ve simulated 1.5mm versus 3mm changes that, in the context of other changes, truly were different. We’ve created custom treatment plans with 80% projection changes and 50% projection changes to portray possible outcomes. From complex reconstructions to orthognathic cases and facial contouring, MirrorMe is working with surgeons to help make soft tissue planning more reliable and outcomes more predictable. 

Case Example: Facial Feminization

So, let’s walk through an example using facial feminization to see just how powerful individual planning can be. There are two ways to approach soft tissue planning starting with VSP.

The most common method for facial feminization is for surgeons to determine bony movement using virtual surgical planning (also known as VSP). Many surgeons work with specially trained biomedical engineers through vendors to visualize the changes to the bony parts of the patient’s face. This includes changes such as frontal bone reductions, brow contouring, mandibular contouring, genioplasty, and gonial angle changes. There also may be discussions for cheek implants or facial fat grafting for midface changes. If cheek implants need to be custom versus stock in order to achieve the desired outcome, that, too, will be discussed. After meeting with the biomedical engineers, the surgeon will receive a report highlighting the planned changes and will take this information to surgery to help guide their progress. 

Yet, what this first method lacks is consideration of the soft tissue envelope and the aesthetic outcome. 

So, let’s talk about a better method. It is well established in literature that soft tissue does not change at a 1:1 ratio with hard tissue, or bony, changes. Also, different regions of the face respond at different rates. For example, a forward projection of 5mm during genioplasty doesn’t equate to a 5mm change to the patient’s profile. It may be as little as 2mm or as much as 3.5-4mm depending on other patient factors. 

Therefore, it is important to visualize soft tissue changes when surgical planning and this is where the power of MirrorMe lies. Using MirrorMe alongside bony planning services, such as VSP by 3D Systems, IPS by KLS Martin, or in-house solutions gives you the opportunity to finesse the aesthetic outcome to reflect your goals as well as the patient’s goals. This comprehensive approach provides detailed consideration of both function and form which are critical to the success of surgery. 

Working with MirrorMe and using 3D soft tissue planning for preoperative treatment planning creates an opportunity to ensure that all of the goals of surgery are addressed, both functional and aesthetic. By looking closely at possible effects on the soft tissue allows for the most thorough consideration of the aesthetic outcome and is a more results-oriented approach for patient planning. 

How do we do this? 

We start with obtaining as much 3D patient data as possible, from external imaging to DICOM data. All of this is easily submitted to MirrorMe via the platform (no cd’s!) and we then prepare for a Sim Session by aligning the patient data and studying any potential issues revealed by the data.

If the Sim Session is live, or conducted asynchronously, we follow any instructions or guidance provided to create a treatment plan, also called a simulation or a morph, for visualizing the desired outcome. This provides an opportunity for the surgeon to be sure that all concerns and goals are addressed and to review if there are any additional changes that reveal themselves during the visualization. 

After the Sim Session, most surgeons we work with want a Case Report which includes detailed analysis between the treatment plan and the baseline, or preoperative, data. The Case Report can be delivered digitally or printed and shipped and is usually ready within 3-4 business days after final approval is received from the surgeon.

Increase value of care and patient satisfaction

In conclusion, creating a custom plan for soft tissue is just as important as creating a bony plan when the aesthetic outcome of a surgery is an indicator of success. Planning helps with identifying concerns and addressing them prior to being in the operating room and help with patient communication and expectation management. Saving time in the operating room, where hospitals spend ~$1800/minute and aligning patient expectations with realistic goals are two key levers for value-based care and patient satisfaction.