Comparison of Photographic Methods

February 2015 | Volume 14 | Issue 2 | Original Article | 134 | Copyright © 2015

Kristin K. Marcum MD,a Neal D. Goldman MD,c and Laura F. Sandoval DOb

a,bDepartment of Otolaryngology and Department of Dermatology; Wake Forest School of Medicine; Winston-Salem, NC
cThe Goldman Center for Facial Plastic Surgery, Boone, NC

Abstract

BACKGROUND: Photo documentation has become increasing important in medicine, especially given the demand for cosmetic procedures. Standard photography is not always adequate; newer techniques exploring the use of polarized, cross and ultraviolet photography can give detailed information on subtle skin lesions including skin pigmentation and skin surface characteristics.
OBJECTIVE: To use various methods of photography including standard photography, cross polarized light, parallel polarized light and ultraviolet passing photography to assess which method most effectively captures skin features such as texture, pigment, and/ or vascularity.
METHODS: A prospective analysis comparing advanced photographic techniques including standard photography, polarized light photography, cross-polarized light photography and ultraviolet light passing photography. The photos were then evaluated and scored by two experts and a blinded observer to characterize the differences visualized in each type of photography compared to standard photography in terms of subsurface skin features, hypopigmentation, hyperpigmentation, and rhytids.
RESULTS: 9 subjects completed the study. Overall, of the 3 photographic methods compared to standard photography, UV passing most enhanced the visualization of subsurface features and hypopigmentation, with increased hyperpigmentation as well. Enhancement of these features made UV passing best for capturing photodamage. Cross-polarized photography was best for visualizing hyperpigmentation, but also heightened visualization of hypopigmentation and subsurface features such as vascularity. Parallel-polarized photography enhanced visualization of skin texture.
CONCLUSIONS: These methods of photography show a quantifiable and reproducible selective ability to evaluate and document elements such as skin texture, vascularity, and pigmentation. Each of these techniques has unique properties that can add to the precision of the clinical evaluation and can be of particular value to providers of cosmetic procedures where photo documentation has become increasingly important in providing an objective means of evaluating outcomes.

J Drugs Dermatol. 2015;14(2):134-139.

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introduction

Photography has become increasing utilized in the regular practice of medicine. Aesthetic and reconstructive surgeons have depended on photography for the past 50 years for documentation, assessment of operative results, education, and communication among peers.1 Today it has become an increasing integral piece of medical documentation, in some fashion, for most specialties. Cosmetic procedures continue to increase in popularity and accurate documentation with pre and postoperative photographs is essential. Standardized photography provides an objective way of evaluating outcomes after aesthetic and reconstructive procedures and for documentation of pathology and medical conditions being treated.

Patient satisfaction is a significant consideration when determining treatment outcomes. It is not uncommon at a return visit for a patient to not fully appreciate the results of a cosmetic procedure. “Is it better? Can you show me?” Providing patients with an opportunity to study their before and after photos may give them the reassurance they are seeking. Photographs can also be used pre-treatment to discuss realistic goals and expectations for particular treatments. This is even more important as noninvasive cosmetic procedures become increasing popular since the outcomes are often very subtle and may be difficult to appreciate. However, plain photography may not adequately capture these subtle changes. Changes in skin color such as erythema and pigmentation or changes in skin texture such as improvement in fine lines or scarring may be difficult to appreciate and evaluate using traditional standard photography. Glare, lighting, and perspective can all alter a photograph to selectively portray or enhance what we visualize with the naked eye. This is a technique that has been taken advantage of by professional photographers who attempt to highlight their subject’s favorable features and minimize less desirable attributes.

As physicians attempting to alter patient characteristics such as texture, pigment, vascularity, and contour, there may be certain methods of photography that, if used appropriately, will more accurately document these selective characteristics. The objective of this study is to use various methods of photography including standard photography, cross polarized light, parallel

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