Practical Guide to Photographic Documentation

29 Practical Guide to Photographic Documentation

Edward A. M. Ball

Summary

In this chapter, the author describes a simple approach to enable busy hair transplant surgeons to produce high-quality photographs that accurately illustrate changes in hair coverage and density and allow true comparisons to be made. The techniques described will allow photographers with any level of experience to capture highly professional-looking images that can enhance their clinical practice and grow their practice. Photography in hair transplant surgery is a vital part of a hair restoration practice. We describe how to produce photographs that are representative (to give an accurate and honest reflection of the subject), standardized (with an accepted approach within the discipline), reproducible (with a technique that produces consistent comparative images), and simple (so that it is feasible and easily adopted in a busy practice).

Keywords: photography hair transplant hair restoration surgery video digital camera lighting photography consent data protection standard views

Key Points

•High-quality photography is an essential element of modern hair transplant surgery, without which a doctor risks practicing low clinical standards, medicolegal exposure, and an uncompetitive commercial standing.

•The main aim of photography in hair transplant surgery is to capture images that are representative, standardized, and reproducible, in way that is simple to implement.

•Basic principles are discussed to enable photographers of all levels of experience to select appropriate equipment and to get the most out of their camera.

29.1 Introduction

Photographic documentation is a vital part of a hair restoration practice, whether used to demonstrate the quality of your work to prospective patients, illustrate principles in presentations to colleagues, or defend against medical malpractice claims. When done well, clinical photography can showcase your work and strengthen your brand. However, poor-quality photography can look amateurish, dishonest, and expose a clinician to medicolegal risk.

The main aims of photography in hair transplant surgery are to produce high-quality images that accurately illustrate changes in hair coverage and density and allow true comparisons to be made. Photographic documentation should be representative (to give an accurate and honest reflection of the subject), standardized (with an accepted approach within the discipline), reproducible (with a technique that produces consistent comparative images), and simple (so that it is feasible and easily adopted in a busy practice).

Before and after photographs are now commonplace on social media, online hair loss forums, and hair restoration clinics’ Web site galleries. These photographs are often the first experiences that a prospective patient will have of hair restoration. They are therefore very important in shaping public perception of a particular surgeon or, indeed, the discipline of hair transplant surgery.1

This chapter outlines the principles of good clinical photography in hair transplant surgery and describes a general approach that will enable a busy surgeon to capture high-quality images with the minimum of inconvenience and expense. In this chapter, the author describes general principles based on simplicity and reproducibility. The approach can be effective even in a small office environment and requires minimal specialist equipment or postprocessing time (Video 29.1).

29.2 Purpose of Photography in Hair Restoration

•Patient management:

–Clinical photography allows us to record and monitor patient progress and response to treatment (or no treatment). Important photographs include the standard pre-, intra-, and postoperative views with additional views of any abnormalities (scars, skin changes, etc.).

–Global and high-magnification trichoscopic (or dermoscopic) photography aids diagnosis and facilitates discussion with medical colleagues.

•Medicolegal record:

–Photography forms an important part of a patient’s medicolegal record and will assist in defending a medical negligence claim.

•Patient interest and reassurance:

–Patients often forget how they looked before their procedure and may only realize the true success of a hair transplant after being reminded of their preoperative appearance.

•Professionalism and honesty:

–Poor-quality medical photography looks amateurish and suggests a lack of attention to detail in one’s work.

–Nonstandardized, inconsistent, and poor-quality images raise suspicion of dishonesty. A “before” photograph taken using a camera-mounted flash can create overexposure or scalp glare and may exaggerate the extent of hair loss. If paired with an “after” photograph taken without flash, it will produce an inaccurate representation of the degree of change. In the same way, an “after” photograph taken from a different angle can suggest that the true result is not being displayed.

•Marketing:

–There are many opportunities to display photographs showing the results of one’s work on Web site gallery pages, online hair loss forums, print marketing material, social media, email campaigns, and blogs.

•Presentations and education:

–Good-quality images undoubtedly enhance presentations and publications. Photographs and videos of patient results, interesting cases, and new techniques enable us to train new doctors and technicians and further our own professional development.

•Research:

–Global and trichoscopic photographs enable us to document and analyze the response to novel treatments.

29.3 Consent

Clinical photography is accepted as a routine part of a patient’s assessment and record keeping, but it is still essential to obtain the patient’s written consent for the recording and storage of their images.2 Most patients are happy to consent to formal medical photography but find the use of mobile phones in the clinical setting unacceptable.³ The consent process should specify the uses to which the photographs will be put and where they will be displayed.⁴ It is helpful to request specific consent to permit the sharing of photographs with prospective patients, inclusion in presentations to medical peers, or for use on Web sites and marketing materials.

29.4 Data Protection

Patient photographs and videos must be securely archived. Paper documentation has largely given way to e-documentation, which has improved accessibility and convenience for the user. However, this comes with challenges for the doctor, whose responsibility it is to ensure the confidentiality and security of the data.⁵

Smartphone and tablet technology has dramatically changed the way we record and share images in the workplace. Mobile devices may be convenient for taking photographs of interesting cases or for conducting remote clinical assessments through online consultations, but their use raises important issues of data protection and cyber security.

Cloud data storage is highly flexible and convenient compared with local servers or external hard drives and works well for practitioners based at multiple sites; however, clinicians must ensure that appropriate levels of cyber security are in place. Clinicians must be wary of data theft and ensure compliance with the relevant data protection regulations in their locality (such as the Health Insurance Portability and Accountability Act of 1996 [HIPAA] in the United States).⁶

29.5 Room Setup and Equipment

29.5.1 Room Setting

The ideal setting for hair transplant photography is a room with consistent ambient light, adequate space for your chosen light sources, a swivel chair for the patient, and a consistent neutral background color. The room must also allow sufficient distance between the camera and the subject, as determined by the focal length of your lens. Although desirable, the room does not have to be solely dedicated to photography (Fig. 29.1). Even in a small office environment, an effective photography setup can be created using small, portable light sources, and a roller blind as a background.

Fig. 29.1 Photography studio with dual light sources, soft boxes, tripod, and background material. Not all clinics have the space for such a setup.

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