PHOTOGRAPHIC STANDARDS FOR FACIAL PLASTIC SURGERY

Photographic Standards for Facial plastic Surgery was written as a guide for standardized photography.  The article demonstrates photographic series for particular procedures with their corresponding reproduction ratios.

We agree with standardization of reproduction ratios to more accurately document photography.  However, larger scaling is probably the standard for most facial plastic surgeons and provides more relevant information regarding the intended procedure.  For example, the reproduction ratio of 1:10 for the 5 rhinoplasty views seems to be to capture too much extraneous information in the photograph.  A reproduction ratio of 1:9 or 1:8 seems to capture more pertinent information.  Likewise, the base view in rhinoplasty should be 1:4.

There are several points regarding the positioning of the patient’s head during photography which should be mentioned.  The patient’s head should be in Frankfort horizontal plane.  To achieve this practically, a line is imagined from the tragus to the palpated edge of the inferior orbital rim and this line is made parallel to the floor.  If the head is not turned appropriately on the lateral view, you may see eyebrows or eyelashes from the opposite eye.  In the rhinoplasty pictures taken, the right lateral view is turned slightly further away from the photographer.  This can create a subtle illusion of decrease in projection of the nose in the right view versus the left view.

The paper does not discuss a controversial element of what is the preferred method of taking an oblique view photograph.  Some photographers feel that the tip of the nose should lie tangent to the cheek on the oblique view.  Unfortunately, in rhinoplasty, the projection often changes resulting in differing oblique views on pre and post operative rhinoplasty photographs.  In addition, when the nose lies tangent to the cheek, this is often closer to a one/fifth view rather than a true three quarters view.  For precise view of the oblique view, the patient should turn his body 45 degrees from the midline.  This often corresponds to a line parallel to a standing light on a two light setup.  If not utilizing a two light setup, the photographer can place two marks at 45 degrees for the patient to turn their body towards.

The paper does not directly discuss aperture in its discussion, but does so indirectly by its inclusion of several photographs.  As the photographs demonstrate on the 1:3 lateral views, only a small amount of the picture is in focus, but the entire nose can not reliably be documented due to inappropriate focus and aperture setting. The narrower the aperture, the greater the depth of field which can be obtained.  It is crucial to have the entire nose in focus for a rhinoplasty photograph.  This involves using an aperture of at least f12.  In order to accurately use such a narrow aperture, appropriate lighting and a tripod or camera stand are needed to stabilize camera shake.

There are many more nuances of photography.  However, appropriate reproduction ratios and patient positioning are crucial elements for conveying accurate documentation of pre and post procedural changes.
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Shah AR, Dayan SH, Hamilton GS 3rd.  Pitfalls of photography for facial resurfacing and rejuvenation procedures.  Facial Plast Surg. 2005 May;21(2):154-61.

Galdino GM, Vogel JE, Vander Kolk CA.  Standardizing digital photography: it's not all in the eye of the beholder.  Plast Reconstr Surg. 2001 Oct;108(5):1334-44.

Tardy ME.  Principals of photography in facial plastic surgery.  New York:  Thieme Medical Publishers, 1992:16-34.

Baker SR, Cook TA, Simons R, Wang T.  Practice tips:  improving patient photos.  Facial Plastic Times December 1996;17(11):6.

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