Formal training in two-dimensional standardized photographic documentation during residency in plastic surgery

DENADAI, RAFAEL; SUGUIMOTO, ALEXANDRE; GHIZONI, ENRICO; BUZZO, CELSO LUIZ; RAPOSO-AMARAL, CESAR AUGUSTO; RAPOSO-AMARAL, CASSIO EDUARDO

doi:10.5935/2177-1235.2018RBCP0187

RAFAEL DENADAI ^**Corresponding author: Rafael Denadai, Av. Adolpho Lutz, 100 - Cidade Universitária - Campinas, SP, Brazil Zip Code 13083-880, E-mail: denadai.rafael@hotmail.com

Hospital SOBRAPAR, Instituto de Cirurgia Plástica Craniofacial, Campinas, SP, Brazil

ALEXANDRE SUGUIMOTO

Hospital SOBRAPAR, Instituto de Cirurgia Plástica Craniofacial, Campinas, SP, Brazil

ENRICO GHIZONI

Hospital SOBRAPAR, Instituto de Cirurgia Plástica Craniofacial, Campinas, SP, Brazil

Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brazil

CELSO LUIZ BUZZO

Hospital SOBRAPAR, Instituto de Cirurgia Plástica Craniofacial, Campinas, SP, Brazil

CESAR AUGUSTO RAPOSO-AMARAL

Hospital SOBRAPAR, Instituto de Cirurgia Plástica Craniofacial, Campinas, SP, Brazil

CASSIO EDUARDO RAPOSO-AMARAL

Hospital SOBRAPAR, Instituto de Cirurgia Plástica Craniofacial, Campinas, SP, Brazil

*Corresponding author: Rafael Denadai, Av. Adolpho Lutz, 100 - Cidade Universitária - Campinas, SP, Brazil Zip Code 13083-880, E-mail: denadai.rafael@hotmail.com

Conflicts of interest: none.

Figures (8)
Tables (3)

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Figure 1
Simplified schematic representation of the relationship between (Left) viewing angle (º) and (Right) focal length (space between the sensor and optical center of the lens focused to infinity) of wide angle, normal, and telephoto lenses shown in millimeters (mm). As the lens size increases, the focal length increases and the range angle decreases. Fixed lenses have a single focal length (e.g., 105 mm), while zoom lenses show focal length variation (e.g., 18-55 mm). Because the normal focal length of the human eye is approximately 50 mm, normal 50-mm lenses provide a natural, undistorted image. Focal distances of less than 50 mm can produce images with radial distortion and therefore are not recommended for photographing faces. Note: The proportions of distances and sizes in the sketch are not true-to-life.

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Figure 2
Simplified diagrammatic representation of the diaphragm (set of superimposed blades- “leaf shutter”-inside the lens that allows control of the amount of light entering the camera). The diaphragm aperture values are indicated by “f” (in the diagram, from left to right: f/16, f/11, f/8, f/5.6, f/4, f/2.8 and f/1.4). The larger the number, the more closed the diaphragm, and therefore less light will pass through the hole. The aperture of the diaphragm also controls the depth of field (extension of the sharp region [in focus] when taking a picture); the greater the aperture of the diaphragm (i.e., the smaller the number), the smaller the depth of field. In medical photos, maximum clarity of the subject/patient is sought so that details are not lost; this is achieved by adopting small diaphragm apertures, preferably > f8 . Note: The proportions of distances and sizes in the sketch are not true-to-life.

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Figure 3
Simplified schematic representation of the depth of field. A specific anatomical structure (e.g., eyes, ear, or lips) should be standardized as a focal point for each photo view (or pose). Thus, the depth of field is defined by the anterior (A) and posterior (P) areas of the focal plane in which sharpness is acceptable.

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Figure 4
Artificial lighting: Three flashes are carefully arranged to reflect and diffuse light: 2 floodlights attached to diffusers are positioned at 1-1.5 m from the patient at a 45º angle of the patient camera axis and a floodlight attached to a reflector (umbrella) is positioned above and posteriorly to the patient, with incidence of light facing the ceiling. The flashes should be synchronized with the camera shutter. A 30-60-cm distance should be maintained between the patient and the blue background (blue provides sufficient contrast, is complementary to all skin colors, allows greater depth of field, and moderates shadows without overcasting the patient) to avoid shadows. Since the quality and quantity of lighting are constant, configurations with large openings (f>16) and low speeds (<1/125) can be easily achieved. Note 1: Professional support is recommended for initial setup. Note 2: distances/sizes are not true-to-life.

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Figure 5
Simplified schematic representation of patient and camera positions (photographer). The patient should be positioned in the center of an octagon with a radius of 30-60 cm, allowing 360º rotation. To determine the ideal focal length for specific anatomical regions, experimental shots should be taken at different distances. Once the desired photo results have been achieved, the position should be marked on the floor and photos of the same anatomical region should always be based on that mark. In the sketch, in our studio, the distance of 1 m between the patient and camera was standardized to document the complete face (constant illumination, 105 mm lens, ISO 100, speed 1/125, variable aperture). Note 1: The marks on the floor must be made according to the conditions of each studio to maintain photo quality. Note 2: The proportions of the distances and sizes in the sketch are not true-to-life.

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Figure 6
Preoperative (Left) and postoperative (Right) standard 2-dimensional photos (Nikon® D50, constant illumination, 105 mm lens, ISO 100, speed 1/125, aperture 14) of a patient with rhinophyma subjected to nasal reconstruction with a forehead flap. Frontal and basal views (Above and Below, respectively).

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Figure 7
Standard 2-dimensional photos (Canon® 70D; constant illumination; objective 50 mm; ISO 100; speed 1/125; aperture 13) of a patient with rhinophyma subjected to tangential excision with electrocoagulation. Frontal views in the preoperative (Left) and postoperative period (Right).

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Figure 8
Standard 2-dimensional photos of the same patient (). Side views in the preoperative (Left) and postoperative period (Right).

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RF Aprovação final do manuscrito; conceitualização; concepção e desenho do estudo; metodologia; realização das operações e/ou experimentos; redação - preparação do original; redação - revisão e edição. AS Aprovação final do manuscrito; coleta de dados. EG Aprovação final do manuscrito; coleta de dados; redação - revisão e edição. CLB Aprovação final do manuscrito; coleta de dados; redação - revisão e edição. CARA Aprovação final do manuscrito; coleta de dados; redação - revisão e edição CERA Aprovação final do manuscrito; conceitualização; concepção e desenho do estudo; metodologia; realização das operações e/ou experimentos; redação - revisão e edição.

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Table 1
General composition of the photo views for anatomical regions, surgical procedures, and specific deformities²2 Archibald DJ, Carlson ML, Friedman O. Pitfalls of nonstandardized photography. Facial Plast Surg Clin North Am. 2010;18(2):253-66.

3 Persichetti P, Simone P, Langella M, Marangi GF, Carusi C. Digital photography in plastic surgery: how to achieve reasonable standardization outside a photographic studio. Aesthetic Plast Surg. 2007;31(2):194-200.

4 Ettorre G, Weber M, Schaaf H, Lowry JC, Mommaerts MY, Howaldt HP. Standards for digital photography in cranio-maxillo-facial surgery - Part I: Basic views and guidelines. J Craniomaxillofac Surg. 2006;34(2):65-73.-⁵5 Yavuzer R, Smirnes S, Jackson IT. Guidelines for standard photography in plastic surgery. Ann Plast Surg. 2001;46(3):293-300.,⁸8 Hochman B, Nahas FX, Ferreira LM. Photography in medical research. Acta Cir Bras. 2005;20(Suppl 2):19-25.,¹⁴14 Quieregatto PR, Hochman B, Furtado F, Ferrara SF, Machado AF, Sabino Neto M, et al. Photographs for anthropometric measurements of the breast region. Are there limitations? Acta Cir Bras. 2015;30(7):509-16.

15 Swamy RS, Most SP. Preand postoperative portrait photography: standardized photos for various procedures. Facial Plast Surg Clin North Am. 2010;18(2):245-52.

16 Schaaf H, Streckbein P, Ettorre G, Lowry JC, Mommaerts MY, Howaldt HP. Standards for digital photography in cranio-maxillofacial surgery--Part II: Additional picture sets and avoiding common mistakes. J Craniomaxillofac Surg. 2006;34(7):444-55.-¹⁷17 Santo PRQE, Sabino Neto M, Furtado F, Trigo Junior TW, Santo AAQE, Nonato FL, et al. Conhecendo os tipos de arquivo de fotografia JPEG e RAW utilizados em pesquisa. Rev Bras Cir Plást. 2018;33(1):89-95.,¹⁹19 Solesio Pilarte F, Lorda Barraguer E, Lorda Barraguer A, Laredo Ortiz C, Rubio Verdú R. Estandarización fotográfica en Cirugía Plástica y Estética. Cir Plást Iberolatinoam. 2009;35(2):79-90.

20 Henderson JL, Larrabee WF Jr, Krieger BD. Photographic standards for facial plastic surgery. Arch Facial Plast Surg. 2005;7(5):331-3.-²¹21 Gherardini G, Matarasso A, Serure AS, Toledo LS, DiBernardo BE. Standardization in photography for body contour surgery and suction-assisted lipectomy. Plast Reconstr Surg. 1997;100(1):227-37..

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RF Final approval of the manuscript, conceptualization, design and draft of the study, methodology, performance of operations and/ or experiments, writing - preparation of the original, writing - review and editing. AS Final approval of the manuscript, data collection. EG Final approval of the manuscript, data collection, writing - review and editing. CLB Final approval of the manuscript, data collection, writing - review and editing. CARA Final approval of the manuscript, data collection, writing - review and editing. CERA Final approval of the manuscript, conceptualization, design and draft of the study, methodology, performance of operations and/ or experiments, writing - review and editing.

Anatomical Regions/Surgical Procedures/Specific Deformities	Photographic views
Face (full)	Standard
Face (close up)^* * , eyebrows;	Standard + B
Rhytidectomy	Standard + facial expression
Ears	Standard + PA + P(PA) + SM(PA)
Eyelids	Standard + periorbital expression
Mento/cervical ^ , lips;	Standard + extension and cervical flexion
Breasts ^* ***** , clavicles;	Standard
Abdomen ^** ****** , inframammary grooves. B, basal; PA, posteroanterior; P(PA), bilateral profile with PA view; SP(PA), semi profile with PA view; Lo, lateral oral bilateral ; AP’, anteroposterior (frontal view) with smile, labial retractor and spatula in the occlusal plane; P’, profile at rest and maximum intercuspation; SC, supracranial. Note: details of the specific views should be accessed in key references2-5,8,14-17,19-21.	Standard
Hands/fingers	Palmar, dorsal, and lateral views
Cleft lip and palate	Standard, AP’ + B + intraoral
Maxillomandibular/occlusal deformities	Standard + AP’ + P’ + intraoral
Cranial deformities	Standard + SC

Standard: AP, anteroposterior (frontal view); P, right and left profile (or lateral); and SM, right and left semi-profile (or oblique). Facial expression: frontal elevation, frontal contraction, nasal elevation, closing of the eyelids (relaxed and with effort), lip protrusion (beak or whistle), lip retrusion (smile). Intraoral: AP, bilateral lateral and maxillary and mandibular occlusions (with or without palate inclusion). Upper limit:

^*
, eyebrows;
^**
, lips;
^***
, clavicles;
^****
, inframammary grooves. B, basal; PA, posteroanterior; P(PA), bilateral profile with PA view; SP(PA), semi profile with PA view; Lo, lateral oral bilateral ; AP’, anteroposterior (frontal view) with smile, labial retractor and spatula in the occlusal plane; P’, profile at rest and maximum intercuspation; SC, supracranial. Note: details of the specific views should be accessed in key references²2 Archibald DJ, Carlson ML, Friedman O. Pitfalls of nonstandardized photography. Facial Plast Surg Clin North Am. 2010;18(2):253-66.

3 Persichetti P, Simone P, Langella M, Marangi GF, Carusi C. Digital photography in plastic surgery: how to achieve reasonable standardization outside a photographic studio. Aesthetic Plast Surg. 2007;31(2):194-200.

4 Ettorre G, Weber M, Schaaf H, Lowry JC, Mommaerts MY, Howaldt HP. Standards for digital photography in cranio-maxillo-facial surgery - Part I: Basic views and guidelines. J Craniomaxillofac Surg. 2006;34(2):65-73.⁵5 Yavuzer R, Smirnes S, Jackson IT. Guidelines for standard photography in plastic surgery. Ann Plast Surg. 2001;46(3):293-300.⁸8 Hochman B, Nahas FX, Ferreira LM. Photography in medical research. Acta Cir Bras. 2005;20(Suppl 2):19-25.¹⁴14 Quieregatto PR, Hochman B, Furtado F, Ferrara SF, Machado AF, Sabino Neto M, et al. Photographs for anthropometric measurements of the breast region. Are there limitations? Acta Cir Bras. 2015;30(7):509-16.

15 Swamy RS, Most SP. Preand postoperative portrait photography: standardized photos for various procedures. Facial Plast Surg Clin North Am. 2010;18(2):245-52.

16 Schaaf H, Streckbein P, Ettorre G, Lowry JC, Mommaerts MY, Howaldt HP. Standards for digital photography in cranio-maxillofacial surgery--Part II: Additional picture sets and avoiding common mistakes. J Craniomaxillofac Surg. 2006;34(7):444-55.¹⁷17 Santo PRQE, Sabino Neto M, Furtado F, Trigo Junior TW, Santo AAQE, Nonato FL, et al. Conhecendo os tipos de arquivo de fotografia JPEG e RAW utilizados em pesquisa. Rev Bras Cir Plást. 2018;33(1):89-95.¹⁹19 Solesio Pilarte F, Lorda Barraguer E, Lorda Barraguer A, Laredo Ortiz C, Rubio Verdú R. Estandarización fotográfica en Cirugía Plástica y Estética. Cir Plást Iberolatinoam. 2009;35(2):79-90.

20 Henderson JL, Larrabee WF Jr, Krieger BD. Photographic standards for facial plastic surgery. Arch Facial Plast Surg. 2005;7(5):331-3.²¹21 Gherardini G, Matarasso A, Serure AS, Toledo LS, DiBernardo BE. Standardization in photography for body contour surgery and suction-assisted lipectomy. Plast Reconstr Surg. 1997;100(1):227-37..

[1] *Corresponding author: Rafael Denadai, Av. Adolpho Lutz, 100 - Cidade Universitária - Campinas, SP, Brazil Zip Code 13083-880, E-mail: denadai.rafael@hotmail.com

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Formal training in two-dimensional standardized photographic documentation during residency in plastic surgery

ABSTRACT

Introduction:

Methods:

Results:

Conclusion: