Practice management | PrAcTIcE PhoTogrAPhy | wall for the patient to view in the lateral


position can help with standardising the head alignment. The Frankfort plane is used as a


reference line for correct head positioning in an X-ray film and has also been used by physicians as a standard for head alignment


when


photographing the face. Some physicians choose to use the natural horizontal facial plane for alignment9, 10


. The Frankfort plane is a Lighting is one of the


most important variables to standardise in cosmetic


photography because it can dramatically change the


appearance of the patient with even the slightest of changes.


, and can cause noticeable changes in jaw definition and submental soft tissue12 The natural horizontal facial plane is


horizontal plane that transverses the top of the tragus (external auditory canal) across the infraorbital rim11


.


achieved when the patient looks straight ahead as if looking into a mirror at eye level10


. This is


preferred for use in plastic surgery photography, and in patients that have low-set ears10


.


Lateral facial alignment having the subject open his/her mouth and checking commissure alignment can perform proper alignment of the lateral side of the face. This helps to prevent over or under side-to-side rotation of the head. To help correct the up and down orientation of the head, vertically align the brow with the chin. consistency in head alignment from photographs taken at different time intervals is important. Placing a sticker on each wall at eye level height and asking the subject to point their nose at it can achieve this.


Lighting Lighting is one of the most important variables to standardise in cosmetic photography because it can dramatically alter the appearance of the patient with even the slightest of changes. All


light has 74 ❚ colour


depending on its wavelength. our eyes


July 2011 | prime-journal.com


have the ability to correct for colour differences in light; the camera, however, does not. This can be easily demonstrated by taking a photograph in ambient light without the use of a flash. your photograph will have an orange colourcast. Using a daylight balanced flash in your photography will help prevent this so you can depict a more accurate colour for your patient’s skin. Not only do you want to


use a flash, you want to use multiple flashes. Using a single on-camera flash can


produce harsh contrasting of the shadows and highlights. There is not one lighting technique that


can produce the proper lighting for all procedures, so decisions need to be made before setting up your lights. The size of the area, the clinic workflow, and the staff experience are all factors that should be addressed prior to choosing lighting techniques for your photography.


Generalised lighting The typical studio lighting setup has two flashes (strobes) positioned at 45° angles and 3–6 feet away from the subject. This studio lighting produces an overall


easily reproducible, and works


well for most face and body procedures. It also provides an efficient clinic workflow. This lighting setup is best used in a clinical setting where multiple staff members are assigned to photograph. This ensures that lighting variables are controlled


Facial lighting The preferred lighting technique produces a more three-dimensional effect of the facial structure. This lighting technique is performed in a similar way to the generalised lighting technique, but the lights are positioned above and closer to the subject. This causes shadows to be created by the


dorsum, nasolabial folds, and jawline. The disadvantage of this technique is that it is


more prone to produce inconsistencies between comparative photographs because the slightest change in flash positioning can produce a dramatically different result rendered by the shadows. This technique would be recommended for clinics that have a person trained in medical photographic techniques, a clinic that provides more space for different photographic setups, and one that is limited to photographing just a few different types of procedures.


Cellulite lighting There are some procedures that are better depicted with different studio lighting set-ups. These set-ups can become more time-consuming and more prone to inconsistency and reproducibility because the lights are being repositioned for specific procedures. The advantage is more definition of the skin, contour, and facial features. one such lighting technique is for cellulite, which aims to emphasise the skin’s tone and texture, and is accomplished by placing the flash above and approximately 1–2 feet in front of the subject. This produces harsher shadows but gives the skin more definition. An additional light placed behind the subject and pointed at the backdrop can reduce background shadows.


even distribution of light, is


Focal length and camera- to-subject distance Photography has changed dramatically in the past 10 years and the use of digital over 35 mm is commonplace in health care. These changes have called for changes in standardising patient photography. This is most evident in the control of focal length and distance. correct


focal length and


subject-to-camera distance need to be controlled for patient photography to avoid unwanted distortion. Before digital cameras, using a fixed focal length lens in manual focus mode performed correct focal length. The photographer would move back and forth to the patient in order to achieve focus rather than using auto-focus. This technique ensured that the correct distance and focal length were used for the area being photographed9


.


With the advent of digital cameras, this technique can be reproduced, but often consumer zoom lenses are used, making it more difficult. The photographer should be aware of the focal length being used and place identifying markers on the floor


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