Photography is rapid and noninvasive, and high-quality images can be obtained relatively easily with careful attention to basic techniques. Photography can be performed in the consultation room and provides a permanent record that can be stored digitally and transmitted electronically. Standardized “before” and “after” or sequential images can be taken, providing invaluable backup in case of queries or disagreements about the outcomes of treatment. Table 8-1 summarizes the uses of photography in cosmetic surgery.

The most important objective when setting up a cosmetic surgery photography system is to be able to produce high-quality, reproducible images that permit adequate assessment and comparison between time points. Factors such as the setup costs of photographic equipment, printing, and computer hardware/software support, as well as arrangements for the secure storage, retrieval, and transmission of images, need to be carefully considered. Finally, the need to assure patient anonymity and confidentiality, to obtain informed consent for photography, and to ensure that images cannot be altered inappropriately or tampered with, also need to be considered.

The advance of digital photography technology and the fall in the cost of equipment has led to the increasingly widespread adoption of digital imaging in cosmetic surgery. Table 8-2 compares the two methods.

Conventional 35-mm photography offers superior resolution over digital imaging, but it can be more difficult to master and to produce reproducible images at different time points because of the variability introduced by different film batches, exposure, lighting, and development processes. Conventional photography can also require bulkier equipment than digital imaging and lacks the instant-preview facility of digital photography. Processing and printing of conventional film needs to be carried out professionally and can be expensive.

Digital photography offers instant imaging and previewing, without the delay or expense of processing. It also offers easy, convenient image storage, retrieval, databasing, and electronic transmission. Even basic digital images, though of lower resolution than analogue photographs, provide sufficient detail for diagnosis and monitoring in cosmetic procedures.

Basic, inexpensive digital equipment can provide high-quality images, but for high-end photography, more specialized (and costlier) equipment may be appropriate. A significant advantage of digital imaging in cosmetic procedures is the ability to manipulate images electronically to show patients how the results of treatment might appear.

Potential drawbacks of digital photography include high initial start-up costs (although the costs of digital systems have fallen as technology has improved), the possible need for staff training in new technology, and the cost of printing digital photographs, software, and computer backup. It can be more difficult to obtain consistent high-quality digital images, and the potential for inappropriate or unauthorized image manipulation may be greater with digital photography.

Consistency is key when documenting the results of cosmetic procedures over time or when images are required for medicolegal purposes. As well as standardizing the physical environment and equipment used for cosmetic surgery photography, the use of standard protocols for cosmetic surgery photography are essential. There should be consistency in positioning of the subject. Ideally, cosmetic surgery photography requires a point-source flash to avoid the elimination of shadows caused by the more widely used ring flash. The background should be plain matte black or midblue. Exposure should ideally be set manually and must be consistent for “before” and “after” images to avoid differences in visible detail. The number
of images taken should be standardized. The distance between subject and camera should be uniform, and different lenses should be used to produce images of the desired size for different applications (e.g., full face and neck at a scale of 1:10 for documentation of rhytidectomy; close-up imaging of single features at a scale of 1:2 to show details of skin texture or incision lines). Specific views should be standardized for repeat photographs (e.g., frontal and lateral views in facial imaging, upper or lower body images). Photographs should be taken at specific intervals to document the outcomes of treatment or healing. Finally, specialized techniques or equipment should be considered for optimal results. These include ultraviolet light or polarized light, frequency of imaging, and inclusion of reference markers.