There are many reasons it is imperative to obtain photographs to document the before and after appearance of cosmetic dermatology patients, as most of us who practice this specialty have learned first-hand. Virtually all of us have had patients who swear they did not have certain wrinkles until after they were injected or that they don’t see any difference in their nasolabial creases. Many of us have also had the opportunity to lecture or teach and wished we had a more diverse collection of before-and- after photographs from which to choose. Fortunately, very few cosmetic dermatologists are compelled to document the pre-treatment condition of a particular patient in the course of a malpractice case, but this too is an important reason to make such documentation standard operating procedure in every cosmetic dermatology practice.
Simple Protocol is Key
Unfortunately, most dermatologists are not photographers by avocation and only learn about photography to the barest minimum just to ensure adequate images. (I myself fall into this category, but have learned a great deal from my friend and colleague Ashish Bhatia, M.D.)
Having a simple protocol for patient photography is essential. This means taking steps to standardize not only the method of taking representative photographs, but also of storing/cataloging them for efficient retrieval for presentations and patient use.
The key to this is to simplify the process and make the number of photos required for each patient uniform.
Standardize the Poses
Ashish taught me that one of the most important aspects of medical photography — more important than equipment or software — is to standardize the poses so that any employee can take pictures that are publication quality.
For instance, a standardized pose for a patient receiving injections for nasolabial creases includes:
• a frontal image
• a 45-degree left image
• a 90-degree left image
• a 45-degree right image
• a 90-degree right image.
Setting Up the Shot
In order to guarantee that the angles are the same for each 45-degree photo taken for a particular patient, the patient should be instructed to turn his or her head until the tip of the nose overlaps with the edge of the person’s cheek. The 90-degree pose is also simple and should be taken with the person pointed at a right angle to the camera.
For nasolabial creases, the most helpful photograph in my practice is one that shows the area of interest — the bottom of the nose to the inferior aspect of the chin. This image must be captured with the person looking straight ahead and without the face pointing either up or down. Having the head pointed upward results in the less-than- glamorous “nostril shot” that never looks quite right. In an ideal world, this shot would be accomplished with downward lighting so that the full depth of the crease can be appreciated.
The full-face image should also be standardized so that all images from a particular patient have the same content without needing to be cropped. My standard protocol is to take a frontal shot that spans from the frontal forehead to the bottom of the chin. I then take 45-degree and lateral photographs, which I find give me adequate photographs for most of what I need.
I find oblique angles useful for patients undergoing other procedures such as Sculptra injections for facial atrophy for which the correction is usually seen best at oblique angles. I take several photographs that are between 45 and 90 degrees, and I discard those I consider sub-optimal. Physicians who perform liposuction and fat transfer may also find multiple oblique photographs helpful.
Standardize the Background
A common problem that I have seen during my visits to other offices is the use of various backgrounds within the office. Problems posed by this are multiple, but the most important is that the focus of attention for a photograph may be on the wallpaper of the exam room or the laser sitting behind the patient rather than on the clinical image. A second problem created by lack of standardized backgrounds is the shadowing that will occur without some material behind the subject. Finally, most digital cameras use a computer weighting system that will focus partially on the subject and partially on the wall behind them, blending the distances and focusing on neither.
Putting a background behind the subject helps to make the person the center of attention for your camera.
Equipment Selection
In my office, we have several (at least three to four) systems that are marketed by Canfield. Most of these are utilized for the various clinical trials that we conduct and they are excellent for this. We also use the Visia system, but have found that for our most common patients getting Botox or fillers, it may not be the optimal set up and instead use our regular Nikon system.
I believe that most cosmetic physicians would do fine with a standardized set of poses and that some of the hardware and software marketed is not practical for real-world patient care or office space constraints.
Storing the Images
Storing digital images is as much an art as taking them. There are many good software programs to help manage the files created.
I use a simple file system and label system that has the person’s name, date, and whether the photograph is before or after a particular procedure (which is also named on the card). Before and after photos are stored by patient name so they are easily searchable when patients wants to see their images.
Patient Consultations
Whether or not to use before and after photographs during your patient consultations is a function of your style and personality, and I think that either way can be successful.
In my own practice, however, I don’t use photographs to morph before and afters or offer numerous before and after photographs to demonstrate my results, because I believe these practices set people up for unrealistic expectations.
A Useful Investment
For the cosmetic dermatologist, photography is essential. Good photographs can help you manage an unrealistic or forgetful patient and provide documentation of what actually transpired. Photographs can be useful for marketing and for publications. All of these are reasons to learn more about photography and invest in a camera, background and system that provide reproducible, high-quality photographs.
There are many reasons it is imperative to obtain photographs to document the before and after appearance of cosmetic dermatology patients, as most of us who practice this specialty have learned first-hand. Virtually all of us have had patients who swear they did not have certain wrinkles until after they were injected or that they don’t see any difference in their nasolabial creases. Many of us have also had the opportunity to lecture or teach and wished we had a more diverse collection of before-and- after photographs from which to choose. Fortunately, very few cosmetic dermatologists are compelled to document the pre-treatment condition of a particular patient in the course of a malpractice case, but this too is an important reason to make such documentation standard operating procedure in every cosmetic dermatology practice.
Simple Protocol is Key
Unfortunately, most dermatologists are not photographers by avocation and only learn about photography to the barest minimum just to ensure adequate images. (I myself fall into this category, but have learned a great deal from my friend and colleague Ashish Bhatia, M.D.)
Having a simple protocol for patient photography is essential. This means taking steps to standardize not only the method of taking representative photographs, but also of storing/cataloging them for efficient retrieval for presentations and patient use.
The key to this is to simplify the process and make the number of photos required for each patient uniform.
Standardize the Poses
Ashish taught me that one of the most important aspects of medical photography — more important than equipment or software — is to standardize the poses so that any employee can take pictures that are publication quality.
For instance, a standardized pose for a patient receiving injections for nasolabial creases includes:
• a frontal image
• a 45-degree left image
• a 90-degree left image
• a 45-degree right image
• a 90-degree right image.
Setting Up the Shot
In order to guarantee that the angles are the same for each 45-degree photo taken for a particular patient, the patient should be instructed to turn his or her head until the tip of the nose overlaps with the edge of the person’s cheek. The 90-degree pose is also simple and should be taken with the person pointed at a right angle to the camera.
For nasolabial creases, the most helpful photograph in my practice is one that shows the area of interest — the bottom of the nose to the inferior aspect of the chin. This image must be captured with the person looking straight ahead and without the face pointing either up or down. Having the head pointed upward results in the less-than- glamorous “nostril shot” that never looks quite right. In an ideal world, this shot would be accomplished with downward lighting so that the full depth of the crease can be appreciated.
The full-face image should also be standardized so that all images from a particular patient have the same content without needing to be cropped. My standard protocol is to take a frontal shot that spans from the frontal forehead to the bottom of the chin. I then take 45-degree and lateral photographs, which I find give me adequate photographs for most of what I need.
I find oblique angles useful for patients undergoing other procedures such as Sculptra injections for facial atrophy for which the correction is usually seen best at oblique angles. I take several photographs that are between 45 and 90 degrees, and I discard those I consider sub-optimal. Physicians who perform liposuction and fat transfer may also find multiple oblique photographs helpful.
Standardize the Background
A common problem that I have seen during my visits to other offices is the use of various backgrounds within the office. Problems posed by this are multiple, but the most important is that the focus of attention for a photograph may be on the wallpaper of the exam room or the laser sitting behind the patient rather than on the clinical image. A second problem created by lack of standardized backgrounds is the shadowing that will occur without some material behind the subject. Finally, most digital cameras use a computer weighting system that will focus partially on the subject and partially on the wall behind them, blending the distances and focusing on neither.
Putting a background behind the subject helps to make the person the center of attention for your camera.
Equipment Selection
In my office, we have several (at least three to four) systems that are marketed by Canfield. Most of these are utilized for the various clinical trials that we conduct and they are excellent for this. We also use the Visia system, but have found that for our most common patients getting Botox or fillers, it may not be the optimal set up and instead use our regular Nikon system.
I believe that most cosmetic physicians would do fine with a standardized set of poses and that some of the hardware and software marketed is not practical for real-world patient care or office space constraints.
Storing the Images
Storing digital images is as much an art as taking them. There are many good software programs to help manage the files created.
I use a simple file system and label system that has the person’s name, date, and whether the photograph is before or after a particular procedure (which is also named on the card). Before and after photos are stored by patient name so they are easily searchable when patients wants to see their images.
Patient Consultations
Whether or not to use before and after photographs during your patient consultations is a function of your style and personality, and I think that either way can be successful.
In my own practice, however, I don’t use photographs to morph before and afters or offer numerous before and after photographs to demonstrate my results, because I believe these practices set people up for unrealistic expectations.
A Useful Investment
For the cosmetic dermatologist, photography is essential. Good photographs can help you manage an unrealistic or forgetful patient and provide documentation of what actually transpired. Photographs can be useful for marketing and for publications. All of these are reasons to learn more about photography and invest in a camera, background and system that provide reproducible, high-quality photographs.
There are many reasons it is imperative to obtain photographs to document the before and after appearance of cosmetic dermatology patients, as most of us who practice this specialty have learned first-hand. Virtually all of us have had patients who swear they did not have certain wrinkles until after they were injected or that they don’t see any difference in their nasolabial creases. Many of us have also had the opportunity to lecture or teach and wished we had a more diverse collection of before-and- after photographs from which to choose. Fortunately, very few cosmetic dermatologists are compelled to document the pre-treatment condition of a particular patient in the course of a malpractice case, but this too is an important reason to make such documentation standard operating procedure in every cosmetic dermatology practice.
Simple Protocol is Key
Unfortunately, most dermatologists are not photographers by avocation and only learn about photography to the barest minimum just to ensure adequate images. (I myself fall into this category, but have learned a great deal from my friend and colleague Ashish Bhatia, M.D.)
Having a simple protocol for patient photography is essential. This means taking steps to standardize not only the method of taking representative photographs, but also of storing/cataloging them for efficient retrieval for presentations and patient use.
The key to this is to simplify the process and make the number of photos required for each patient uniform.
Standardize the Poses
Ashish taught me that one of the most important aspects of medical photography — more important than equipment or software — is to standardize the poses so that any employee can take pictures that are publication quality.
For instance, a standardized pose for a patient receiving injections for nasolabial creases includes:
• a frontal image
• a 45-degree left image
• a 90-degree left image
• a 45-degree right image
• a 90-degree right image.
Setting Up the Shot
In order to guarantee that the angles are the same for each 45-degree photo taken for a particular patient, the patient should be instructed to turn his or her head until the tip of the nose overlaps with the edge of the person’s cheek. The 90-degree pose is also simple and should be taken with the person pointed at a right angle to the camera.
For nasolabial creases, the most helpful photograph in my practice is one that shows the area of interest — the bottom of the nose to the inferior aspect of the chin. This image must be captured with the person looking straight ahead and without the face pointing either up or down. Having the head pointed upward results in the less-than- glamorous “nostril shot” that never looks quite right. In an ideal world, this shot would be accomplished with downward lighting so that the full depth of the crease can be appreciated.
The full-face image should also be standardized so that all images from a particular patient have the same content without needing to be cropped. My standard protocol is to take a frontal shot that spans from the frontal forehead to the bottom of the chin. I then take 45-degree and lateral photographs, which I find give me adequate photographs for most of what I need.
I find oblique angles useful for patients undergoing other procedures such as Sculptra injections for facial atrophy for which the correction is usually seen best at oblique angles. I take several photographs that are between 45 and 90 degrees, and I discard those I consider sub-optimal. Physicians who perform liposuction and fat transfer may also find multiple oblique photographs helpful.
Standardize the Background
A common problem that I have seen during my visits to other offices is the use of various backgrounds within the office. Problems posed by this are multiple, but the most important is that the focus of attention for a photograph may be on the wallpaper of the exam room or the laser sitting behind the patient rather than on the clinical image. A second problem created by lack of standardized backgrounds is the shadowing that will occur without some material behind the subject. Finally, most digital cameras use a computer weighting system that will focus partially on the subject and partially on the wall behind them, blending the distances and focusing on neither.
Putting a background behind the subject helps to make the person the center of attention for your camera.
Equipment Selection
In my office, we have several (at least three to four) systems that are marketed by Canfield. Most of these are utilized for the various clinical trials that we conduct and they are excellent for this. We also use the Visia system, but have found that for our most common patients getting Botox or fillers, it may not be the optimal set up and instead use our regular Nikon system.
I believe that most cosmetic physicians would do fine with a standardized set of poses and that some of the hardware and software marketed is not practical for real-world patient care or office space constraints.
Storing the Images
Storing digital images is as much an art as taking them. There are many good software programs to help manage the files created.
I use a simple file system and label system that has the person’s name, date, and whether the photograph is before or after a particular procedure (which is also named on the card). Before and after photos are stored by patient name so they are easily searchable when patients wants to see their images.
Patient Consultations
Whether or not to use before and after photographs during your patient consultations is a function of your style and personality, and I think that either way can be successful.
In my own practice, however, I don’t use photographs to morph before and afters or offer numerous before and after photographs to demonstrate my results, because I believe these practices set people up for unrealistic expectations.
A Useful Investment
For the cosmetic dermatologist, photography is essential. Good photographs can help you manage an unrealistic or forgetful patient and provide documentation of what actually transpired. Photographs can be useful for marketing and for publications. All of these are reasons to learn more about photography and invest in a camera, background and system that provide reproducible, high-quality photographs.
