Karl Waked1, Jin Ye Yeo2
1Plastic and Reconstructive Surgery Department, Brussel Universitair Ziekenhuis (UZB) - Vrije Universiteit Brussel (VUB), Belgium; 2JOVS Editorial Office, AME Publishing Company
Correspondence to: Jin Ye Yeo. JOVS Editorial Office, AME Publishing Company. Email: jovs@amepc.org
This interview can be cited as: Waked K, Yeo JY. Readers’ Choice: Author Interview with Dr. Karl Waked. Journal of Visualized Surgery. 2025. Available from: https://jovs.amegroups.org/post/view/readers-rsquo-choice-author-interview-with-dr-karl-waked.
Expert introduction
Dr. Karl Waked (Figure 1) is a certified plastic, reconstructive, and aesthetic surgeon. He completed his residency at the renowned plastic surgery department of Brussels University, with additional international training in Paris, Munich, and Marbella. He specializes in aesthetic and reconstructive breast surgery, body contouring surgery, gluteal aesthetics, and facial aesthetic surgery. Dr. Waked has published over 20 articles in international peer-reviewed journals and has presented his latest research in meetings all over the world.
Dr. Waked also has a profound interest in business and technology and founded a MedTech company in 2018, called Augmented Anatomy. Together with a team of doctors and technology experts, the company aims to visualize individual anatomy through Augmented Reality (AR).
Dr. Waked’s article, “State-of the-art review on the renal and visceral protection during open thoracoabdominal aortic aneurysm repair”, published in our journal, has received an outstanding readership and entered the journal’s Most Read Article List.
Figure 1 Dr. Karl Waked
Interview
JOVS: Your article “State-of-the-art review on the renal and visceral protection during open thoracoabdominal aortic aneurysm repair” was highly recognized. What drew your initial interest to this topic during your residency?
Dr. Waked: During my residency, I also completed a rotation in the cardiac surgery department at the St-Jan Hospital in Bruges. At that time, the chief of the department was Dr. Marc Schepens, a world leader in cardiac surgery, with a specific interest and focus on thoraco-abdominal aortic aneurysm (TAAA) repair. His mentorship and guidance during my training there still have an impact on my current career and the advice he gave me helped me to be where I am today. I will be forever grateful for that.
Although a TAAA repair is one of the most complex and challenging surgeries within the field of cardio-thoracic surgery, Dr. Schepens made it look easy. Everything was controlled, planned, and executed perfectly. It was an amazing surgery to watch and to assist. He suggested to collaborate on an article to describe the current literature on renal and visceral protection during TAAA repair and include his own protocol and experience into the manuscript. I happily accepted this opportunity, and in all honesty, it almost drew me towards a career as a cardiac surgeon.
JOVS: What inspired you to transition from vascular-focused surgery during residency to specializing in plastic, reconstructive, and aesthetic surgery?
Dr. Waked: I always had an interest in plastic and reconstructive surgery, because of the combination of medicine, creativity, and innovation. In Belgium, the residency always starts with 2 years of general surgery, after which you transition into plastic surgery. With regards to microvascular surgery (for example in free tissue transfers), there are a lot of similarities with cardiac surgery (mostly in cardiac bypass surgery), so I truly enjoyed my time in Bruges as well. I always knew I wanted to become a surgeon, mainly because of the technical aspects of the craft and the precision that is involved. Plastic and reconstructive surgery for me is the main specialty that combines surgery, technology, creativity, art, innovation, and business. That combination and variety within my craft is what ultimately made the difference.
JOVS: In the field of aesthetic and reconstructive breast surgery, body contouring, and facial aesthetics, what advancements do you find most promising?
Dr. Waked: As my focus is guided more and more towards reconstructive and aesthetic breast and body contouring surgery, the innovations I am actively following are tissue engineering, tissue and skin rejuvenation, skin retraction technologies, and artificial intelligence. Tissue engineering is truly promising within reconstructive breast surgery, and may render our free flap surgeries obsolete once it is really applicable. The power of fat harvesting and fat grafting, and all the new innovations that are published around the power of fat and the cell types within fat, are truly remarkable and will definitely be a paradigm shift within all areas of plastic and reconstructive surgery: skin rejuvenation, treatment of joint pain, reverse aging, treat sequellae of radiotherapy, improve scar healing, etc.
Skin retraction technology is a true game-changer in body contouring surgery, as it is the missing element in a lot of procedures where you deal with skin laxity. By using the power of radiofrequency, you can enhance collagen fiber contraction and collagen production, thus improving skin laxity in all areas of the body. It can even avoid skin excision, which is a very welcome evolution for a lot of patients looking to improve the contours of the neck, arms, torso, or legs.
And lastly, the power of artificial intelligence (AI) will be noticeable in every field of medicine, not only plastic surgery. Although we are only at the beginning of this evolution, I am eager to follow this closely and apply its benefits to improve surgical planning, surgical safety, and post-surgical recovery.
JOVS: You founded Augmented Anatomy in 2018. What motivated you to explore the intersection of technology and surgery?
Dr. Waked: I have always been interested in technology since I was a child. Augmented Reality (AR) is an amazing innovation that is applied in many areas of our lives, such as architecture, gaming, and business. Within medicine, I think that neurosurgeons were the first to really adopt AR in their procedures and they definitely have made the most progress in the last few years. After I read an article on the use of AR in free flap surgery of the lower leg (they visualized, although in a still rudimentary way, the main vessels of the lower leg through AR), I got interested in applying this technology to other areas of the body. I gathered a few colleagues, including a plastic surgeon and a radiologist, and we founded Augmented Anatomy, a company with a focus on visualizing human anatomy through augmented reality. Our first product, Artery 3D, uses the magnetic resonance imaging (MRI) of a patient’s face, to visualize the individual facial arterial anatomy, and help the surgeon perform surgical or aesthetic procedures in a safer and more efficient way. I do believe that the applications of AR in surgery are endless, so I am looking forward to more developments in the future.
JOVS: How has AR enhanced surgical visualization, and what impact does it have on precision and patient outcomes?
Dr. Waked: When being able to “see through the skin”, you can better plan your procedure, and be more efficient during the procedure. Knowledge of the human anatomy remains of course crucial for every surgeon, but the variations in the individual anatomy may result in unexpected surprises or complications. When pre-operative imaging can help to visualize the anatomy through AR, a surgery or procedure can be better planned and executed. Artery 3D specifically focuses on the facial arterial anatomy and is a useful tool for aesthetic facial injections in order to avoid an intra-vascular injection and subsequent embolization of an artery towards the skin (causing skin necrosis) or the retina (causing blindness). The same technology can be used to prepare a facial reconstructive procedure, such as a forehead flap for nose reconstruction, to visualize the nurturing branch of the flap (in this case the supratrochlear artery) and correctly plan the flap design and dissection with limited risk of arterial damage. In free flap surgery, we often rely on pre-operative imaging, to visualize the vascular branches that must be included in the flap. These are then located on the skin, often using an X- and Y-axis. The use of AR can help the surgeon to truly visualize the arterial anatomy (and surrounding tissues) to better plan and execute flap surgery. This is of course still in development, as correct intra-operative tracking remains the biggest challenge to solve. Once fine-tuned, this will make surgeries faster, more efficient, and with fewer complications and better outcomes.
JOVS: What challenges have you faced in developing and implementing AR technology in medical practice? How did you overcome them?
Dr. Waked: Specifically for our product, the first challenge was to accurately visualize the arterial anatomy with an MRI without the use of contrast. A contrast-free MRI is a completely harmless imaging technique for the patient, so we wanted to make this work. It took some time to develop an accurate protocol that was applicable to most MRI machines worldwide. Thanks to the help of Prof. Dr. Marc Mespreuve (radiologist and co-founder of Augmented Anatomy), we succeeded, and this is now part of the software package of all 3T and some 1.5T MRI machines of GE, Siemens, and Philips worldwide.
The next challenge was to fine-tune the segmentation and separation process of the images and create a 3D visualization of the arterial network. By not using a contrast agent, it is more difficult to isolate them from the surrounding tissues. It took a lot of man-hours, but we managed to develop an algorithm to successfully overcome this step. Recently, we also implemented AI to further enhance this part of the development process and further improve the workflow.
Last but not least, accurate tracking of a patient’s face was crucial to render a trust-worthy AR-projection of the arteries. We cannot accept a deviation of a few millimeters, as it would render our technology obsolete and useless. It also needed to be dynamic, meaning the position of the vessels needs to change with different facial expressions. We employed some bright engineers to help us with this part of the development process.
Every application of AR in visualizing the human anatomy needs to successfully complete this 3-part process. The technology and workflow that we have developed certainly form a good basis for the application of AR on other body parts. But every new product will need a lot of fine-tuning to make it accurate and precise. Some steps will be easier, such as segmenting the vessels from a contrast-enhanced computed tomography (CT) image or tracking vessels of the lower leg that are bigger and less tortuous than facial arteries. However, the true challenge remains to keep accurate tracking during open surgical procedures, where you potentially lose fixed tracking points. Neurosurgery has overcome this by using fixed tracking points around the patient’s head, but we are not there yet in plastic surgery. I am curious to see where we will be in 5 years.
JOVS: Looking ahead, what impact do you hope to make in both the surgical and MedTech fields in the coming years?
Dr. Waked: My aim is to become an expert in my field, which is reconstructive and aesthetic breast and body contouring surgery. I am strongly involved in the developments I spoke earlier about, such as AR, AI, skin retraction, and tissue rejuvenation, so I aim to contribute to the growing number of scientific discoveries and publications in these areas. Can you imagine that one day, we may be able to reverse the aging process by the power of specific cells in our fat tissue? Or that we may engineer a complete breast in the lab to help patients towards a successful breast reconstruction? Performing a complete surgical procedure using AR glasses sounds cool as well, don’t you think?
These developments are currently happening on a global scale. It is impossible to focus on everything. However, as a founder of a company at a young age (I was 28), it would be fun to have the opportunity to be part of the advisory board of other companies or start-ups as well, that are involved in one of these interesting fields. So, who knows what the future may bring? This is what makes my job so interesting, and I learn new things every day.