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Before-and-after photos can be a powerful tool — but consistency is crucial

Article-Before-and-after photos can be a powerful tool — but consistency is crucial

Whether you need to capture before-and-after results of a cosmetic procedure for patients or for publication, photo systems can be one of the most valuable of all office tools for a cosmetic practice, yielding everything from a portfolio of a surgeon's work, to documentation in medicolegal situations. Today, the surgeon's toolkit for capturing patient before-and-afters runs the gamut from simple digital cameras, to UV imaging, simulation software, and multi-component, state-of-the-art lighting and positioning systems.

Dr. Bhatia
APPLES TO APPLES For all the high-tech bells and whistles, however, the most critical factor for before-and-after comparisons, consistency, often remains highly questionable — even sometimes in the most prestigious medical journals. "It's really appalling to see some of the inconsistency out there," laments Ashish Bhatia, M.D., an assistant professor of clinical dermatology at Northwestern University's Feinberg School of Medicine in Chicago who spoke recently on the subject at the American Society for Dermatologic Surgery annual meeting. "So many factors in an image can be influenced by poor lighting or positioning, and they can cast doubt on the quality of the true results," he tells Cosmetic Surgery Times. "On the other hand," he adds, "you might be doing a really beautiful treatment with great results and you may under-represent it with photos that have poor consistency." Dr. Bhatia outlines three basic steps to help achieve consistency with patient photography.

POSITIONING "Positioning is a key in taking consistent photos," he says. "There are plenty of positioning systems, but some can take up space and take time to use," he explains. "We have a few in our office and they're great for studies but not necessarily when we're taking pictures on a busy clinic day." As an alternative, Dr. Bhatia instructs his staff to use a standard format of two frontal views, two lateral views and two oblique views. Some tools, such as Profect's Ultra II software program, help with positioning by enabling an overlay image to allow for patient alignment in before-and-after photos.

LIGHTING The use of flash, ambient lighting, and white balance need to be consistent across all photos, Dr. Bhatia points out, as even the most subtle variations can cast shadows or illuminate areas, distorting results. The background of a photo also comes into play in regard to light. A common mistake, he notes, is to use a daylit room as a studio.

"People will often use a room with big light discrepancies due to different amounts of light coming in throughout the day. That will change the color of the picture," Dr. Bhatia explains. "So a suggestion would be if you use a room with a window, make sure it has opaque blinds and you will always get good color consistency."

Dr. Starr
BACKGROUND & SUBJECT Few offenses are as widely and blatantly committed in before-and-after photos as changes in the patient's appearance — changes unrelated to the treatment. Variance in items from make-up and facial expression to hair color and jewelry can severely distort before-and-after comparisons. Dr. Bhatia's solution? Bar them all. "We have patients remove all makeup and jewelry for the photos and have them put their hair back in the same type of hairband each time," he says. He also uses black bibs to cover up clothing. "In addition to covering the clothes, the black bibs offer an ideal background for the patient's face to stand out. It's important to remove all of those distractors so that you can accurately compare the images." Perhaps the most difficult factor to precisely control is a patient's facial expression, as even the slightest differences in expression can make a wrinkle appear or disappear. Dr. Bhatia says one helpful tip to nullify facial expressions is simply to have patients close their eyes if it's not an eyelid procedure. "They tend to make fewer expressions and react less when their eyes are closed," he suggests. "I find that really helps."

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