Photography In Plastic Surgery Research Articles

Foucault and Clinical Photography: An Analysis and Mitigation of the Clinical Gaze in Pediatric Craniofacial Plastic Surgery

While objectification in medicine has been extensively critiqued as a philosophical concept dating back to the Ancient Greeks and contemporarily popularized by Michel Foucault, the impact of objectification through clinical photography in plastic surgery is often overlooked. Plastic surgery patients are by necessity subjected to the clinical gaze through clinical photography, which may lead to experiences of dehumanization and alienation from their physicians and surgeons. In this essay, we explore the concept of the clinical gaze in clinical photography from a structured philosophical lens, and offer one potential answer to this problem. First, we draw upon Foucault’s well-known and monumental critique of contemporary Western medical practice from Birth of the Clinic alongside a brief history of clinical photography to illustrate the problem of the “clinical gaze.” Then, we argue that mitigating the clinical gaze is critical for the flourishing of patients in general and plastic surgery patients in particular. Finally, we offer our attempt to mitigate the clinical gaze that was conducted by the Craniofacial Anomalies Program at the University of Michigan in 2014 as a demonstration of an upending of the power dynamic usually at play.

Picture Perfect: Standardizing and Safekeeping Clinical Photography in Plastic Surgery.

Abstract Plastic surgery relies heavily on clinical photography to document preoperative and postoperative changes, visualize surgical approaches, and evaluate outcomes. However, the contemporary landscape of plastic surgery photography faces challenges, including a lapse in standards due to the prevalence of smartphones, social media platforms, and security concerns related to data storage and cyberattacks. In this comprehensive review, the authors aim to provide plastic surgeons with practical guidelines for achieving standardized, high-quality clinical photography while navigating the evolving landscape of technology, security, and ethical considerations. We explore the security challenges associated with storing clinical photographs, emphasizing the legal obligations under the Health Insurance Portability and Accountability Act (HIPAA). We also discuss various storage options, including HIPAA-compliant cloud services, electronic medical records, and emerging technologies like blockchain and artificial intelligence. Level of Evidence: 5

Evolving the Cybersecurity of Clinical Photography in Plastic Surgery.

Point-of-care photography and photo sharing optimize patient outcomes and facilitate remote consultation imperative for resident surgeons. This literature review and external pilot survey study highlight the risks associated with current practices concerning patient privacy and biometric security. In a survey of 30 plastic surgeon residents and attendings, we found that the majority took photos of patients with their iPhones and shared them with colleagues via Apple iMessage. These findings corroborate previous reports and highlight a lack of physician user acceptance of secure photo-sharing platforms. Finally, we frame a successful example from the literature in the context of a postulated framework for institutional change. Prioritizing the privacy and safety of patients requires a strategic approach that preserves the ease and frequency of use of current practices.

Who Owns the Patient's Photographs? Consent and Legal Ramifications of Photography in Plastic Surgery.

Who Owns the Patient's Photographs? Consent and Legal Ramifications of Photography in Plastic Surgery.

Guidelines for the Standardization of Genital Photography.

Plastic surgery relies on photography for both clinical practice and research. The Photographic Standards in Plastic Surgery laid the foundation for standardized photography in plastic surgery. Despite these advancements, the current literature lacks guidelines for genital photography, thus resulting in a discordance of documentation. The authors propose photographic standards for the male and female genitalia to establish homogeneity in which information can be accurately exchanged. All medical photographs include a sky-blue background, proper lighting, removal of distractors, consistent camera framing, and standard camera angles. We propose the following guidelines to standardize genital photography. In the anterior upright position, feet are shoulder-width apart, and arms are placed posteriorly. The frame is bounded superiorly by the xiphoid-umbilicus midpoint and inferiorly by the patella. For circumferential documentation, frontal 180 degree capture via 45 degree intervals is often sufficient. Images in standard lithotomy position should be captured at both parallel and 45 degrees above the horizontal. Images of the phallus should include both the flaccid and erect states. Despite the increasing incidence of genital procedures, there lacks a standardized methodology in which to document the genitalia, resulting in a substantial heterogeneity in the current literature. Our standardized techniques for genital photography set forth to establish a uniform language that promotes more effective communication with both the patient as well as with colleagues. The proposed photography guidelines provide optimal visualization and standard documentation of the genitalia, allowing for accurate education, meaningful collaborations, and advancement in genital surgery.

The Evolution of Photography and Three-Dimensional Imaging in Plastic Surgery.

We read with extreme interest the article by Weissler et al, entitled “The Evolution of Photography and Three-Dimensional Imaging in Plastic Surgery” published in the March of 2017 issue of the Journal.1 We congratulate the authors for this ambitious undertaking, which presents a historical review of the fascinating progress made in photography in plastic surgery and highlights the clinical utility of three-dimensional imaging in our practice. As observed in the article, this technology appears to be the most appropriate to provide an objective evaluation of outcomes, especially when a volume change is included as a primary goal of the operation. The implications for procedures such as fat grafting are certainly remarkable, as a volumetric and morphologic analysis demonstrating true surface dimensions both preoperatively and postoperatively becomes available. Among the many, one of those implications refers to clinical studies reporting or comparing fat graft survival achieved using different techniques, which in the future will require documentation with objective measures of the recipient-site volume at the baseline and at postoperative follow-up visits.

The Evolution of Photography and Three-Dimensional Imaging in Plastic Surgery.

Throughout history, the technological advancements of conventional clinical photography in plastic surgery have not only refined the methods available to the plastic surgeon, but have invigorated the profession through technology. The technology of the once traditional two-dimensional photograph has since been revolutionized and refashioned to incorporate novel applications, which have since become the standard in clinical photography. Contrary to traditional standardized two-dimensional photographs, three-dimensional photography provides the surgeon with an invaluable volumetric and morphologic analysis by demonstrating true surface dimensions both preoperatively and postoperatively. Clinical photography has served as one of the fundamental objective means by which plastic surgeons review outcomes; however, the newer three-dimensional technology has been primarily used to enhance the preoperative consultation with surgical simulations. The authors intend to familiarize readers with the notion that three-dimensional photography extends well beyond its marketing application during surgical consultation. For the cosmetic surgeon, as the application of three-dimensional photography continues to mature in facial plastic surgery, it will continue to bypass the dated conventional photographic methods plastic surgeons once relied on. This article reviews a paradigm shift and provides a historical review of the fascinating evolution of photography in plastic surgery by highlighting the clinical utility of three-dimensional photography as an adjunct to plastic and reconstructive surgery practices. As three-dimensional photographic technology continues to evolve, its application in facial plastic surgery will provide an opportunity for a new objective standard in plastic surgery.

Perfect Lighting for Photography in Plastic Surgery

INTRODUCTION: Photograph is indispensable for plastic surgery. On-camera flashes can result in bleached out detail and color. This is why most of the plastic surgery clinics prefer studio lighting similar to professional photographers’.1,2 We want to share a simple alternative: Ring light (Fig. 1).Figure 1: Photograph of DIY ring light.MATERIALS AND METHODS: We took five different photographs of the same person with five different camera and lighting settings (Fig. 2): Smartphone and ring light point and shoot camera (PSC) and on- camera flash; PSC and studio lighting; digital single lens reflex (DLSR) camera and studio lighting; DSLR and ring light. Then, those photographs were assessed objectively with an online survey of five questions answered by three distinct populations: plastic surgeons (n: 28), professional portrait photographers (n: 24) and patients (n: 22) who had facial aesthetic procedure.Figure 2: Photographs of 72-year-old female subject taken with five different camera and lighting settings. Row A: Smartphone and ring light. Row B: Point and shoot camera and its on-camera flash. Row C: Point and shoot camera and ring light. Row D: Digital single lens reflex camera and studio lighting. Row E: Digital single lens reflex camera and ring light.RESULTS: Compared to the on-camera flash, studio lighting better showed the wrinkles of the subject. Ring light facilitated the perception of the wrinkles by providing homogenous soft light in circular shape rather than bursting flashes. Combination of DSLR camera and ring light gave the oldest looking subject according to 64% of responders. DSLR camera and the studio lighting demonstrated the youngest looking subject according to 70% of the responders. The majority of the responders (78%) chose the combination of DSLR camera and ring light that exhibited the wrinkles the most. CONCLUSION: We suggest using ring light to obtain well-lit photographs without loss of detail. We strongly advise not to use smartphone if you want to achieve standardized pictures.

Photographies en chirurgie plastique : pratiques, usages et législation

Photography in plastic surgery is omnipresent. Through its various uses, it may present both ethical and forensic risks. The objective of this study is to analyze the use of medical photography by the plastic surgeon, the perception of this use by the patient, and consequence of such use. A questionnaire about the use of medical photography was assessed to 629 plastic surgeons. A questionnaire was given to patients, about their perception of the use of photography by their surgeon. One hundred and seventy-six surgeon's questionnaires and 93 patient's questionnaires were analyzed. For 97.7% of the responding surgeons, the proportion of patients refusing to be photographed was less then 1/20. The objective of the photography was especially medicolegal for 62.5% of the surgeons, especially for following the patient progress (87.5%), partially for the formation (72.1%), partially for scientific publications (57.8%) and not at all for the personal publicity (73.1%). Surgeons often share his photographs with others surgeons (71.1%), sometimes with others medical personnel (48.8%). The security and the access to photographs were determined to be correct for 67.6% of the surgeons and perfect for 23.3%. In total, 17.2% of the surgeons obtained a written consent, 41.4% obtained an oral consent, and 38.5% did not request patient consent. It was found that 48.3% of the surgeons and 40.2% of the patients think that the right to the photographic images belong to the patient. Medical photographs expose the plastic surgeon to medico-legal risks. He must know and follow the law in order to prevent eventual legal proceedings.

Digital Photography in Plastic Surgery

Sir:FigureWe read with great interest the article by Sanniec et al. entitled “Adherence to Photographic Standards: A Review of Plastic Surgeon Websites,”1 and we agree with the authors that photographs are essential in a plastic surgeon's practice. Although several articles have been published on this subject, medical publications/presentations and Web sites continue to appear that fail to satisfy clinical photography standards.2 These images are valuable for various purposes, including the following: creating models for preoperative planning, providing visual references during surgery, assessing surgical outcome, sharing data and experience with colleagues, communicating with patients to clarify their treatment plan, educating residents, and preparing presentations and publications. Moreover, photographs should be an integral part of the patient clinical record, in addition to informed consent, because they could represent one of the few elements of a physician's defense in medicolegal issues. In fact, today, most plastic surgeons, at some point in their career, have to address a complaint filed by a patient about their clinical performance, which may be followed by litigation. Because of the increasing importance of photographs, standardization according to well-established criteria is necessary to obtain significant and comparable images to be used in lawsuits. Very small variations can cause notable changes and may decrease markedly the value of clinical photography.3 Maintenance of constant camera settings, lighting, accurate positioning of subjects, no post–image acquisition changes using computer software, and use of identical views and patient preparation will significantly increase standardization.4 On this topic, in 2007, our group published an article in the journal Aesthetic Plastic Surgery entitled “Digital Photography in Plastic Surgery: How to Achieve Reasonable Standardization Outside a Photographic Studio.”5 In this article, on the basis of the medical literature and our own experience, we reported general criteria concerning patient preparation and camera setting and specific criteria for accurate image capture within different anatomical areas. The aim of our letter is to emphasize the importance of digital photography for plastic surgeons during medicolegal litigation; emphasize that plastic surgeons should use standardized photographic criteria; and raise awareness about some criteria, published in 2007 by our group, that we currently use in clinical practice. Use of strict digital photography guidelines that control all image characteristics will significantly enhance the potential of these images to objectively illustrate the plastic surgeon's work. Achille Aveta, M.D. Angela Filoni, M.D. Paolo Persichetti, M.D., Ph.D. Plastic Surgery Unit, University Campus Bio-Medico of Rome, Rome, Italy DISCLOSURE The authors have no financial interest to declare in relation to the content of this communication.

Reply

Sir:FigureWe are writing in response to the letter by Achille Aveta et al. entitled “Digital Photography in Plastic Surgery: The Importance of Standardization in the Era of Medicolegal Issues.” This letter serves to support and further expand on our previously published abstract, “Adherence to Photographic Standards: A Review of Plastic Surgeons Websites.”1 In their letter, Aveta et al. stress the importance of photographic standardization and the value that this imparts. As we have also stated, they note that standardization is critical for preoperative planning, providing visual references during surgery, assessing surgical outcomes, communicating with patients, surgical education, and presentations and publications. They go on to further elaborate that patient photographs are a critical element of the medical record and may serve to protect plastic surgeons if malpractice legal claims are levied. We agree with the statements made in this letter. Patient photographs provide one of the few objective means of assessing clinical outcomes following plastic surgery. In 2006, the American Society of Plastic Surgeons/Plastic Surgery Educational Foundation published Photographic Standards in Plastic Surgery2 to provide a template for photographic standardization. The American Society of Plastic Surgeons strives to promote the highest standards in its members, improve clinical outcomes, and distinguish our specialty as leaders in this ever-changing field as other specialties encroach on us. Adherence to photographic standards provides appropriate documentation, increases professionalism, allows critical analysis of surgical results, and allows for better education, both for surgeons and for patients and the public. Aveta et al. appropriately state that high-quality, standardized photographs can be a valuable adjunct in the face of litigation. Continued appraisal of our performance and results is important for improving outcomes. Our study demonstrated that a minority of plastic surgeons' Web sites upheld the desired photographic standards.1 Education of plastic surgeons regarding these standards will possibly lead to their more universal application. William J. Casey III, M.D. Kyle Sanniec Alanna M. Rebecca, M.D. Division of Plastic and Reconstructive Surgery, Mayo Clinic in Arizona, Phoenix, Ariz. DISCLOSURE The authors have no financial interests or commercial relationships to disclose regarding the preparation, presentation, or submission of this communication.

Digital Photography in Plastic Surgery: How to Achieve Reasonable Standardization Outside a Photographic Studio

Accurate photographic documentation has become essential in reconstructive and cosmetic plastic surgery both for clinical and scientific purposes. Digital imaging systems currently are popular, being reasonably affordable and much improved in quality. They offer multiple advantages in terms of quality, easy image storage and retrieval. Nevertheless, obtaining standardized, consistent, and relevant digital images is not easy outside a photographic studio. The purpose of this report is to define guidelines for accurate image capture in different anatomic areas, following elementary general criteria based on practical issues beyond the purely theoretical, to obtain reasonable standardization, consistency, and reproducibility.

Guidelines for standard photography in plastic surgery.

Uniform patient photographs that create permanent records are essential for any visually oriented medical specialty. These images are valuable for any plastic surgeon's practice for various reasons; thus, standards and recommendations for clinical photography should be well-known. There are several articles published on this issue, but it is still not uncommon to be exposed to medical publications and presentations that fail to satisfy clinical photography standards. This stimulated an interest in reviewing the important factors that are essential to achieve consistent, comparable clinical photographs with 35-mm single-lens reflex photography.

Clinical Photography in Plastic Surgery

Clinical Photography in Plastic Surgery

Clinical photography in plastic surgery

Clinical photography in plastic surgery

Clinical Photography in Plastic Surgery

Clinical Photography in Plastic Surgery

Suggestions for standardized clinical photography in plastic surgery.

Standard equipment for photography in plastic surgery is described, as well as a series of standard views of the human body. The need for reliability and the possibilities of misrepresentation in clinical photography are discussed. The need for standards in clinical photography is stressed.