Photodocumentation in facial plastic surgery is essential in the perioperative setting, and with meticulous uniformity and standardization it serves as the primary tool for surgical planning and critical analysis of results. Accurate photodocumentation is dependent on strict and consistent use of equipment, lighting, and patient positioning. The purpose of this article is to review the principles of standardization in perioperative patient photography for common facial plastic procedures and to provide the facial plastic surgeon with the tools necessary to develop consistent and accurate patient photographs.
The famous adage “a picture is worth a thousand words” could not be more fitting in the realm of facial plastic surgery. Surgical planning and assessment of successful outcomes would be impossible without use of consistent and accurate photodocumentation. In addition, assessments of novel techniques are inherently dependent on proper patient photographs and are critical to promote scientific development and surgical education. Clinical portrait photographs have become as integral a part of the patient’s record as radiographs, and it is critical that strict standardization of photographic technique is employed at all times. It is the purpose of this review to elucidate methods to consistently achieve standardized, high-quality images for specific facial plastic surgery procedures by describing proper equipment, lighting, and patient positioning.
Camera and lens
Single-lens-reflex (SLR) 35-mm cameras had been the gold standard for patient photodocumentation, but with the advent of digital SLR photograph technology 35-mm film SLR cameras are no longer recommended. Digital cameras offer many new advantages such as instantaneous pictures, ability to crop and adjust on a computer, and provision of images that can be easily stored and filed. Although point-and-shoot cameras are less expensive, the resolution of these models is generally lower than that of the digital SLR cameras. Digital SLR cameras also afford the ability to change lenses and adjust settings that control aperture size, shutter speed, and exposure. While digital resolution technology is approaching the level of resolution of 35-mm film (the equivalent of 35 million pixels), a resolution of 1.5 million pixels (megapixels) is acceptable for medical photography. The authors generally recommend a 5-megapixel camera or higher.
In terms of choice of lenses, a lens with a longer focal length, in the range of 90 to 105 mm with macro capability, is recommended to capture pertinent details of facial anatomy. These lenses produce the best balance of distortion and provide the largest depth of field to ensure the whole face is in focus.
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