CHAPTER 2 Photography for the Male Aesthetic Patient
Summary
Photography for the male aesthetic patient is a critical element of documentation as in all facets of plastic and reconstructive surgery. This resource is a high-yield reference for both novice and experienced practitioners. Topics covered include camera settings, logistics for setting up an office studio, standard views, and general pearls and pitfalls to achieve high-quality photographs.
Introduction
Medical photography is often underappreciated in residency training. The terminology is challenging, and there is a general perception that great photos require professional staff, expensive equipment, and specialized facilities. However, standardized photography’s importance in board collection, preoperative planning, patient counseling, postoperative evaluation, and documentation is paramount to the plastic surgeon.
Many references and book chapters on medical photography are lengthy, technical, and daunting. The goal of this chapter is to provide a concise reference for medical photography, with emphasis on the male patient. We will discuss basic terminology, equipment, and photographic standards, with tips and tricks for integrating photography both efficiently and effectively into your practice.
Terminology
It is important for the plastic surgeon to have a rudimentary understanding of the language and terminology in photography.
Basic Photography Terms
Depth of Field
The area in focus on either side of your target (focal plane).
Improves with:
Smaller aperture.
Shorter lens (i.e., wide angle).
Greater distance.
The depth of field is the range of the subject that will be in focus. Depth of field is dependent on a number of variables that are discussed below. For most medical photos, all features need to be in focus, so a larger depth of field is desired.
Aperture (f/stop)
Amount of light allowed to pass through the shutter during exposure.
Smaller aperture allows a greater depth of field, but needs more light (i.e., brighter flash).
The aperture, or f/stop, is essentially the diameter of the lens opening. Aperture is determined by f/# (i.e., f/11, f/16), and the higher the number, the smaller the aperture. Small apertures allow for greater depth of field and should be used for most, if not all, medical photographs.
Shutter Speed
Amount of time the light strikes the sensor.
Longer exposure can make a blurry image.
Shorter exposure needs a larger aperture to capture the image.
Shutter speed is the total time that the shutter opens and allows light to strike the sensor. Longer speeds allow more light exposure but can cause blurry images. Conversely, short speeds yield crisp images but require larger apertures to permit adequate light to pass through the shutter. For medical photography, shutter speeds will be relatively short and the default settings in most cameras can generally be used.
Lens
Larger lenses have a lower angle of curvature (telephoto).
Smaller lenses have a larger angle of curvature (wide angle).
Large lenses are good for close-ups (macro).
Smaller lenses are good for full-body shots.
To oversimplify yet spare the reader from a discussion of optical physics, think of smaller lenses as having wider angles of curvature (wide angle) and larger lenses more gentle angles of curvature (telephoto). “Wide-angle” lenses (50 mm) better emulate how we see the world, and are useful for landscapes, full-body shots, and group photos. In medical photography, they are useful because the photographer can capture large, close objects in their entirety.
Telephoto lenses (90–105 mm) are useful for “macro” images (i.e., intraoperative) and facial photos. Moderate telephoto lenses minimize distortion of features for “close-up” shots. However, the larger the lens, the further the photographer must be from the object for it to remain in focus. In essence, the photographer must stand further from the object to take an in-focus “close-up” shot. This is an important consideration when tight spaces are taken into account.
Camera Controls
Most, if not all, needs can be met with a reasonably portable, 35-mm or equivalent digital camera (5–10 megapixel) with magnification factors capable of matching 100- and 50-mm lenses. Camera settings and controls can be daunting. Below are brief descriptions and tips for basic settings. It is critical to keep the camera settings, lighting, background, and positioning standard for all photographs.
Exposure Mode
Exposure modes are settings to help optimize shutter speeds and apertures for the desired setting. Most cameras have the options P (programmed), S (shutter priority), A (aperture priority), and M (manual). Because depth of field is critical for medical photography, aperture priority is generally the ideal setting.
Metering Mode
Light meters are standard on most modern cameras. Metering modes are settings that determine the camera’s exposure based on light reflected to the light meter. The default setting is often “matrix metering,” which divides the entire view frame into zones and analyzes them individually by light and dark. For this reason, low-contrast backgrounds have the least impact on light metering and exposure.
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