Photographic Standards


Photographic Standards for Plastic Surgeons


The American Society of Plastic Surgeons has done a great  job in establishing standards for plastic surgeons taking before and after photos of patients. This includes a publication called “Photographic Standards in Plastic Surgery” and a PDF version is available for your viewing.

Another publication that is available is the Resident Resource Book from the University of Texas Medical Branch. Starting on Page 31 this publication has some great information on photo techniques and reproduction ratios for Plastic Surgery before and after photos. Using their camera to subject distances and lens focal length (50mm-100mm) for different body shots will give you the correct reproduction ratios meeting professional standards.  Keep in mind that the angle of view with a given focal length with a digital camera is different than that of a 35mm film camera. So if you are using a Canon, or Nikon digital S.L.R. all of the before and after photos can be taken using a 50mm lens the equivalent of a 75mm lens on a 35mm film camera.Photographic Standards

After reviewing these publications it would seem that there would be universal compliance with the photographic standards that have been set for plastic surgeons, but that is definitely not the case.

If  you review the publication it becomes very apparent that taking before and after photos as being done in most plastic surgeons offices is far from the professional standards that have been set. A whole list of problems that this has created could be listed including loss of revenue. What needs to be done is setting up an area in your office dedicated to taking patient photos with the right equipment and staff training. The small investment in equipment will start to show a return immediately. If you already have studio lights and a Digital SLR camera the Camera Track sells for as little as $1995.

The most efficient way to accomplish this is to contact Jim Canterbury at The Digital Pro LLC. What I will need is a list of the Camera, and Lighting  that your office is using, and the dimensions of the room that is being used including ceiling height. After receiving this information I will layout  the studio and recommend any additional equipment you will need.

  • The first item that is addressed is “Camera to Patient Distance”  this issue is resolved using the over head Camera Track all of your Before and After Photos will be taken from the same height and distance for each patient and those measurements will be recorded for future reference. When changing the camera from vertical to horizontal the lens will remain centered with  the rotating camera bracket.
  • In order to keep the exposure and color balance consistent the wall that is being used for the background will need to be painted 18% grey. (Using the paint mix code for Home Depot ).
  • Lighting needs to be “Locked Down” so the studio lights should be mounted on the side walls rather than using movable stands.
  • If you have been using a zoom lens on the camera this will need to be replaced with a fixed standard or Macro lens.
  • A target mat needs to be placed for the patient to stand on.
  • Design a Patient Photo Form with information needed to repeat settings when taking photos in later sessions.
  • Train staff on how to use equipment and record settings.

2 thoughts on “Photographic Standards

  1. My photo rooom could benefit from your suspended camera track system, and I would welcome your comments and suggestions. I have a dedicated photo room, without windows, 9’4″ long x 62″ wide x 8′ high, with midnight blue matte wallpaper on the rear wall, beige side walls, and an off-white acoustic tile ceiling. I have a Norman P400D light source with wall-mounted Norman LD4B lights located a bit asymmetrically on the side walls (because of the entry door)–the base of the reflectors are located as follows: (photographer’s) right side 77″ up from the floor and 35″ forward from the entry wall; left side 77″ from the floor and 21″ forward from the entry wall. My old film SLR has been replaced for some time with a small Canon point-and-shoot that, I have realized, does not trigger the slaves. I plan to buy a new digital SLR, probably the Canon EOS Rebel with 50mm and 100 mm lenses; I have used Canons for 40 years. Also, I assume a radio trigger will simplify use of the slaves.

    My dermatologist officemate wants to get a small frame with a fixed-position head mount with a chin rest but that will obviously not do for a plastic surgeon who needs to see necks. How do you suggest getting consistency of neck extension with your system? We would want a system that the staff could use.

  2. Hi; Dr. Cedars

    I wish this had came a day earlier because I returned home out of the Oakland Airport on Friday.
    This afternoon using the measurements that you sent me I laid out the equipment in my office to see it your room will work and it is a bit tight but okay. I set up an office studio in Seattle that was almost the same size.
    Here are my recommendations:
    Paint the background wall with 18% flat gray paint. This will make a huge difference in how the digital camera will adjust the color balance and exposure.

    The room is not wide enough for soft boxes and having the lights mounted up at 77″ creates shadows that you do not want to have in the photos. Also using electronic flashes with the digital camera requires a lot of adjustments and using the camera in the manual mode. When using daylight balanced lighting the camera can be used in any of the auto modes and give consistent results. I have attached a PDF file and on page four there are photos of the wall mounted florescent tubes that cost $395 a pair on the same page there are photos of the office in Seattle showing the mounting plates they installed for the camera track. (You can probably sell the Normans on Craig’s list and money ahead).

    The Canon Rebel would work with a 50mm lens (if you have a 50mauto focus Canon lens left over from your film camera that will work) you do not need the 100mm lens for what you will be doing. On the last page of the PDF is a chart with the camera to subject distances for the photos you will be taking. I will send you a color chart that can be used to fine tune the camera. In most cases the best set up would be to have the camera set to the aperture priority mode (AV on the top dial) and set the f-stop at f 4.0, ISO set at 800, and the white light balance set for daylight fluorescent. Now it is set up for point and shoot for all the different poses.

    I set up a system for facial photos that where being taken to show frown lines using a head mount-chin rest system. I do not think that this is the way the dermatologist would want to go.
    When taking facial photos use a stool with rotating top (24″ stool from Target Cherry Wood finish padded top $40) and the ring light (page 4 of PDF) to fill in and ad contrast. Have the patient sit down sitting straight up and adjust the camera height so the focusing circle in the viewfinder of the camera is centered on the nose. Take the first shot then have the subject rotate to the different angel positions and take photos. Another trick that can be used is to have markers on the side walls for the subject to look at while positioning for different photos (not just facials). If you could email samples of what the Dermatologist needs that would be helpful.

    We also need to talk about software and printing before and after photos. A lot of doctors take try to crop their photos with camera and take them from different distances for different size patients by doing this they create a whole new set of problems. What should be done is to take them all using the standard reproduction ratios and if they are going to be printed then use software to crop them keeping the originals as taken. If you ever need them for a legal issue this would be a real life saver. I have also attached a resident hand book that is a great reference on patient photos starting on page 31.
    My recommendation would be to use the Picasa software to file and print your photos (used to sell for $100 now free from Google). With the Canon Digital cameras the aspect ratio does not match standard paper sizes by using the Picasa software you can prepare the images for printing and see how the will look before having them printed and crop if you want. The best practice would be to have your photos printed on photo paper do by a photofinisher it will save both time, and money while giving you professional quality prints to show to patients. Another trick is that if you have before shots available your staff can view them when taking follow up photos “just to make sure they are matching up with the before shots. This would really help with facial photos where the position and neck extensions are more critical.

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