A plastic surgeon's office is no place for an anxiety-stricken perfectionist like myself, but there I was about to get a consultation for a breast augmentation.
I have never thought about changing my breast size, or that much about my breasts at all for that matter, but as a 28-year-old woman, my life has held endless periods of just generally wanting to look different. At those times, I might have tried a psychologist before opting for cosmetic surgery. Yet some people feel that surgery affords them the opportunity to look into a mirror afterward and genuinely like what they see.
For two thirds of British patients, however, feeling positive about that reflection is replaced with a feeling of regret, according to a 2014 survey by Medical Accident Group of 2,638 people that had undergone cosmetic surgeries. Remarkably, only 32 percent of those taking part in the survey had properly researched the procedure.
It's reasons like this that have Gary Ross, a consultant plastic, reconstructive, and aesthetic surgeon, starting to use virtual reality (VR) and 3D simulations in his practice. Tools, he says, that help manage an individual's expectations and add further certainty to the decision they're making.
"The use of 3D and Goggles is all information that's being given to the patients," Ross says. "When you're using them, you start spending more time with people. As soon as you've got that sort of engagement, they're more open and transparent. It's more understanding of what they want."
Ross is employing a virtual aesthetic software called Crisalix. I'm at his practice in North West England to try it out for myself. He tells me that VR mainly helps him know the size that his patients are looking for. He is predominantly using the technology for breast procedures, but has tried it for facial ones, too. Ross has been using Crisalix for approximately three years. I spoke to other surgeons who had been using it for less time.
"In some ways, I see the tech helping [patients] understand that there may be difficulties after surgery," says Roger Bigwood, clinic director at cosmetic plastic surgery clinic Bella Vou in Kent, England. "So many of them are so motivated to have breasts, for example, that it doesn't matter because they've already made up their minds. As we get more informed, we realize that we should be asking more questions. VR takes on a greater meaning in setting those expectations."
Crisalix takes 2D images of a person's body parts and creates 3D simulations for a tablet and VR headset. In other words, I will be able to see what my chest looks like with countless types of implants before any operation takes place. I'll be able to view the changes from every sort of angle, comparing them to an original version of my body. It's like a no-brainer version of Photoshop in 3D.
I'll get a good idea of size, Ross tells me, but there are limitations with the 3D models when it comes to visually predicting things like shape and symmetry. Before the Crisalix system, Ross would use a sizing kit and 2D images in a patient consultation—things that he still uses today, which the VR and 3D compliment.
With my hands on my hips, Shawcross begins scanning my naked torso with an iPad. It takes approximately thirty seconds for its camera to mark all the points needed to make a digital representation of my body.
When I put on the headset, I am standing in a room of mirrors, each one offering a different view of my potential new breasts. Looking down, I can see them too. It's obviously a virtual world—more vibrant, less detailed and my skin tone's off—but overall it feels pretty real.
The VR consultation lasts for about 15 minutes and, with goggles off, I'm left with the uneasy feeling that I liked my virtually augmented breasts better than my real ones.
Turning to the 3D images of myself, which I can adjust and turn with my finger on the iPad, I can see myself obsessing with them on a screen at home, designing my body to whatever I condone as "better," and destroying the self-confidence that I thought I already had. And I never even wanted a breast augmentation.
"There's nothing wrong with your breasts," says Shawcross. "There's nothing wrong with anybody's breasts. The only reason we scan people is if they want breast surgery. Nobody needs plastic surgery. It's something they want to build their confidence."
Shawcross does not let patients take the pictures home, although many plastic surgeons do, claiming that people benefit from the ability to enlist opinions from family and friends. Instead, Shawcross suggests putting bags of rice, sized to the weight of the implant, into a bra.
"We don't like people to go home and focus on what they're looking at," she says. "We want them to go home and focus on how they feel with the rice bags. Someone could really like the look of a 400cc implant but then they walk around with the weight on them for a couple of days and they think it's too heavy. An image could be totally unrealistic for you."
We ingest a plethora of images on a daily basis and all of these can all have an affect on our body schema—how we perceive ourselves. If that reflection in the mirror doesn't match what our brain perceives it is, or what it thinks it should be, then feeling good about oneself becomes bloody hard. VR can help with that, too.
Brenda Wiederhold is a psychologist in San Diego who uses VR to work with women scheduled for mastectomies, a procedure often leading to depression, as a patient becomes suddenly stripped of one of femininity's defining factors.
"Patients have to really start thinking 'what makes me who I am? It's not just my breasts,'" says Wiederhold. "It's about getting them to reframe that and change what their expectations are and what they think about themselves, letting them go a bit deeper."
Wiederhold has been using VR as a tool in her practice since 1996 and it is with this, paired with traditional therapies, she can help these patients become accustomed to the look of a post-surgery aesthetic. "You have to start teaching them before the mastectomy that their breasts will look different," she says. "If you can use VR to start managing some of those expectations prior to the surgery, it sometimes helps people for the after."
Changing a perception takes time, and with VR, the process of knocking down these ingrained barriers becomes easier, and ironically, more real. For those with eating disorders, for instance, Wiederhold can show a patient what they really look like, comparing that to the distorted image that they have of themselves.
"It's very powerful," she says. "If you show a person with anorexia a picture of a body with the face not visible, they'll say that person is skin and bones and needs to gain some weight. But if you put their head on that same body, they'll think it looks normal. When your brain sees that in 3D, it's very different and they have to admit, even if it's for a moment, that they have a body image distortion."
This is using VR to put a patient back into the driver's seat, strengthening their awareness so they can start to take the steps needed to control their lives in the real world.
Back at the plastic surgery clinic, VR is also informing patients, allowing them to tell surgeons what they want, which, according to Shawcross, is the opposite of what patients do when they first come in. It's also a type of self-check so that the person knows what they've signed up for. Ashley Hunt, who works at Ross' clinic, has had a few cosmetic procedures, including her breasts. She thinks VR is a "gamechanger."
"Some people will go under the knife and not realize how serious what they're doing is," she says. "For them to see what the result will look like, it makes it real for the patient."