Current and Future Photography Techniques in Aesthetic Surgery

Background The rapidly increasing modalities and mediums of clinical photography, use of 3D and 4D patient modeling, and widening implementation of cloud-based storage and artificial intelligence call for an overview of various methods currently in use as well as future considerations in the field. Objectives Through a close look at the methods used in aesthetic surgery photography, clinicians will be able to select the modality best suited to their practice and goals. Methods Review and discussion of current data pertaining to: 2D and 3D clinical photography, current photography software, augmented reality reconstruction, artificial intelligence photography, and cloud-based storage. Results Important considerations for current image capture include a device with a gridded viewing screen and high megapixel resolution, a tripod with leveling base, studio lighting with dual-sourced light, standardized matte finish background, and consistency in patient orientation. Currently, 3D and 4D photography devices offer advantages such as improved communication to the patient on outcome expectation and better quality of patient service and safety. Artificial intelligence may contribute to post-capture processing and 3D printing of post-operative outcomes. Current smartphones distort patient perceptions about their appearance and should be used cautiously in an aesthetic surgery setting. Cloud-based storage provides flexibility, cost, and ease of service while remaining vulnerable to data breaches. Conclusions While there are advancements to be made in the physical equipment and preparation for the photograph, the future of clinical photography will be heavily influenced by innovations in software and 3D and 4D modeling of outcomes.

The Influence of Sagittal Head Tilt on Periorbital Appearance: Implications for Clinical Photography and the Evaluation of Postoperative Results

Background Consistency in standardized periorbital photography – specifically, controlling for sagittal head tilt – is challenging yet critical for accurate assessment of pre and postoperative images. Objectives To systematically assess differences in topographic measurements and perceived periorbital attractiveness at varying degrees of sagittal head tilt. Methods Standardized frontal photographs were obtained from 12 female volunteers (mean age 27.5 years) with the Frankfort plane between -15 o to +15 o. Unilateral periorbital areas were cropped, and topographic measurements were obtained. The images of each individual eye, at varying head tilt, were ranked in order of attractiveness by 11 blinded evaluators. Results Inter & intrarater reliability was excellent (ICC > 0.9). Downward sagittal head tilt was linearly associated with an improved aesthetic rating (Spearman’s correlation; ρ= 0.901, p < 0.001). However, on subgroup analysis, eyes with lower lid bags received the highest aesthetic score at neutral head tilt. Pretarsal show and upper lid fold heights progressively decreased (p<0.001), positive intercanthal tilt became more pronounced (p<0.001), and the apex of the brow (p <0.001) and lid crease (p=0.036) arcs lateralized with downward sagittal head tilt, contributing to a more angular appearance of the eye. Marginal reflex distance (MRD) 1 was maintained while MRD2 progressively increased (p<0.001) with downward head tilt. Conclusions Negative sagittal head tilt significantly improves periorbital aesthetics – however, in the presence of lower eyelid bags, this also increases demarcation of the eyelid cheek junction which may be aesthetically detrimental. Controlling for sagittal head tilt is critical to reliably compare pre and postoperative clinical photographs.

704 An Audit of Marking of Cutaneous Lesions in A Two-Week Wait Skin Malignancy Service

Aim Clinical photography enhances a medical record and facilitates communication with other professionals involved in care. It is utilised frequently in the management of skin malignancy. The essence of good photography lies in accurate identification of the cutaneous lesion in question. National guidelines and local policy advise the use of circumferential marking to delineate a lesion of interest, and an alphabetical system for marking of multiple lesions. We audited compliance to standards for medical illustrations of cutaneous lesions in the two-week wait skin cancer clinic at University Hospital North Durham. Method Prospective audit of patients attending the clinic over a 7-day period (07/09/20-15/09/20). Data was collated from electronic records on a number of variables. Results 175 patients met inclusion criteria. The majority (n = 160, 89.9%) were referred for a single lesion, the rest for multiple lesions. Hospital clinical photography was obtained in 148 patients (83.2%). Marking was deemed inappropriate in 44.6% of those in which clinical photography was obtained. Of these 66 cases, 12 cases were multiple lesions marked without letters, 52 had an incorrect indicator for the lesion (such as arrows or dots, allowing more ambiguous interpretation), and 8 had no indicator at all. Incidentally, one patient was photographed with dressings covering the lesions. Conclusions Compliance with standards for demarcation of skin lesions for clinical photography was found to be poor. This permits the wrong identification of lesions in future treatment episodes and could potentially have a significant impact on care. We propose the introduction of a referral document illustrating correct marking guidelines.

Safe clinical photography: best practice guidelines for risk management and mitigation

Clinical photography is an essential component of patient care in plastic surgery. The use of unsecured smartphone cameras, digital cameras, social media, instant messaging, and commercially available cloud-based storage devices threatens patients’ data safety. This paper Identifies potential risks of clinical photography and heightens awareness of safe clinical photography. Specifically, we evaluated existing risk-mitigation strategies globally, comparing them to industry standards in similar settings, and formulated a framework for developing a risk-mitigation plan for avoiding data breaches by identifying the safest methods of picture taking, transfer to storage, retrieval, and use, both within and outside the organization. Since threats evolve constantly, the framework must evolve too. Based on a literature search of both PubMed and the web (via Google) with key phrases and child terms (for PubMed), the risks and consequences of data breaches in individual processes in clinical photography are identified. Current clinical-photography practices are described. Lastly, we evaluate current risk mitigation strategies for clinical photography by examining guidelines from professional organizations, governmental agencies, and non-healthcare industries. Combining lessons learned from the steps above into a comprehensive framework that could contribute to national/international guidelines on safe clinical photography, we provide recommendations for best practice guidelines. It is imperative that best practice guidelines for the simple, safe, and secure capture, transfer, storage, and retrieval of clinical photographs be co-developed through cooperative efforts between providers, hospital administrators, clinical informaticians, IT governance structures, and national professional organizations. This would significantly safeguard patient data security and provide the privacy that patients deserve and expect.