The Mirror Has a Zillion Faces


We all know roughly how the fairy tale goes: “Mirror, mirror on the wall, who’s the fairest one of all?” asks the Queen.

“You are the fairest of all,” answers the enchanted mirror.

“You don’t think my nose is too big?” asks the Queen.

“Personally, I think it’s fine, but since you mention it, we could thin the bridge a bit and maybe tilt the tip up ever so slightly, like so.” Utilizing magic, the mirror shows the Queen her appearance with the hypothetically adjusted features. The Queen is thrilled with the new look and has the work done immediately.

Dr. Robert Kotler, a Beverly Hills plastic surgeon specializing in cosmetic procedures for the face and neck, has one of those magic mirrors. It’s actually a computer-imaging system using the latest in digital-picturing and morphing techniques to help show prospective patients how they might look after a nose job, face-lift, eye job, chemical peel or other cosmetic procedure.


This demonstration is critical to the surgeon. After 30 years in the operating room, Kotler says he can take one look at a patient and visualize almost perfectly how any given operation will turn out.

“I know what I can achieve because I’ve had the experience of seeing thousands of patients go through the procedures,” Kotler said.

Far more difficult, however, is transmitting that knowledge to the client. Traditionally, plastic surgeons have relied on the time-honored technique of showing new patients before-and-after pictures of others who have had the various procedures. Still, that method only showed how someone else’s surgery turned out--not how the new patient might look.

But now Kotler uses the Mirror 2000 Imaging and Archiving System from Mirror Image Software of Kirkland, Wash. The computer enables the surgeon to quickly create, in effect, a set of before-and-after photos for the new patient before a single incision is made.

The setup uses a powerful, dual-Pentium, Windows NT-based personal computer workstation that’s linked to a three-chip Sony digital video camera. The camera captures photo-quality images of the patient’s face and sends them to the computer for display on a high-resolution monitor.

Then, by drawing on an electronic tablet with a special stylus, Pearl Britto, a counselor in Kotler’s office, can manipulate the patient’s picture. Working with the doctor and the patient, she can create on-screen simulations of the client’s face after surgery: erasing wrinkles, changing the size and shape of the nose, eyes or whatever the procedure calls for.


The Mirror system is designed to blend skin tones accurately and to mimic the response of the tissue of a real face that’s being nipped, tightened and lifted. It usually takes only a few minutes to produce a finished picture of the patient’s postoperative face.

The system can just as easily image whole bodies to show the effects of liposuction or breast enhancement. (Kotler, however, only works on the face and neck.)

“It doesn’t change the way I work in the operating room,” he said. “What it does is better communicates what I can and cannot do, so the patients can see what I think I can deliver.”

For it is in the mind of the patient that Kotler’s most important preoperative work takes place. Few medical specialties involve as much emotional baggage as plastic surgery does. Many prospective patients arrive with what Kotler calls unrealistic expectations, hoping, for example, that a face-lift will make them look exactly the same as they did 40 years ago, or that a chin implant can make them look like a favorite movie star, or that they can get an exact copy of their neighbor’s nose.

“I’m only interested in making changes that look natural,” Kotler said. “This helps show people what they can realistically expect plastic surgery to do for them so they won’t be disappointed.”

Equally important, the imaging system enables patients to see how a change in one area of their face will affect the relative appearance of another part. This facial gestalt, Kotler said, is more important than any single cosmetic element.


Sometimes this sparks clients to get more work than they thought necessary to achieve the cosmetic goal they had in mind. In other instances, Britto said, people see the changes and decide not to have anything done at all.

“One girl sat with me for 40 minutes while I worked on [the image of] her nose, and at the end she just said, ‘You know, I kind of like my nose the way it is.’ ”


Freelance writer Paul Karon can be reached via e-mail at