Dr Emmanuel Elard discusses the importance of standardised photography and debates the issues that surround current clinical photography methods
Practitioners regularly use images to demonstrate successful treatment results and market their services to prospective patients. However, we are often criticised for before and after photographs due to the differences in factors such as lighting and angles, which alone, can change an individual’s appearance. Consistency in imagery is not only demanded by the patient, there is also pressure from the industry and media to produce photographs that are transparent and depict the patient without interference from the surrounding environment. This is shown at congresses, where images are often scrutinised, and in press events, where media often argue that many before and after photographs do not show a true comparison. It is my belief that consistency is an integral part of our aesthetic practice, yet, unfortunately, it seems many practitioners do not understand the importance of photography standardisation.
Photography plays a major role in the everyday lives of aesthetic practitioners, not only in consultations to demonstrate work to new patients, but also in sharing our learning with peers. During consultations, using before and after photographs or videos can help patients to determine a treatment’s quality. As medical practitioners, we need to be able to explain the procedure in detail, noting how a treatment works, as well as manage a patient’s expectation of results. It is essential to have a range of photographs, taken at multiple angles, to do this successfully. Otherwise, how is it possible to reassure patients concerned with losing facial animation following a botulinum toxin procedure if you can’t show them dynamic before and after photographs of your current patients? Another concern is that patients often forget how they looked before treatment, so photographs are useful for making comparisons and demonstrating successful results. For example, I once conducted a dermal filler procedure to correct a patient’s jawline – results were wonderful. However, in the follow-up consultation the patient accused me of creating a lateral deviation in her chin. I showed her a standardised before video and she could clearly see that her chin was deviated before the procedure. My patient was finally happy, apologised, and I did not face a risk of being sued.
Standardising photographs or videos would require factors such as the temperature, exposure, lighting, angles and patient positioning in each image to be exactly same every time.1 These must be kept consistent to allow for a true comparison. Although image standardisation is optimal, aesthetic practitioners are not photographers and many do not have the know-how to achieve standardisation. It is also something that can be very time consuming to get correct. There are also cost implications; so many clinics rely on a smartphone with a blank background and judge factors such as the position and lighting to replicate pictures taken prior to procedures, when there are other points to consider. The main concern for a business hoping to implement standardised photography/videography would come with the cost of equipment such as a good quality camera, tripods, a dedicated room with no windows (just artificial light), specific lights, specific software to classify and edit all photographs and team training.
While some practitioners may not have the knowledge or facilities to achieve complete standardisation, we have to remember that we are in a connected era – patients are rightfully more demanding about information and evidence following procedures and clinics must react accordingly. Certain parameters can be achieved through cost-free ways including phone apps such as Teoxane Aesthepics Premium and Allergan Face to Face that can produce standardised patient positioning. However, to achieve a completely standardised image, business owners can choose to invest in technology that uses a motorised device to travel around a patient with the same background and lighting, producing standardised photographs and videos with consistent light, temperature, shadows, patient positioning and angles, producing much more consistent results. I believe practitioners have a responsibility to become knowledgeable in this area and understand or invest in technology that allows them to take before and after photographs that are as consistent as possible.
There is a lack of official guidance mentioning patient photography. However, some associations such as the BAAPS, recommend that photographs should be taken for all patients undergoing aesthetic medical procedures and that they should be standardised where possible.2
However, declaring that practitioners must adhere to a set standard of imagery is something I feel most people would welcome from an ethical standpoint. Set legislation, requiring clear photographic or video evidence pre and post treatment, could help monitor inadequate practice, improving the reputation of aesthetic practitioners as a whole. It is also my opinion that photographs are not enough – I feel that pictures only tell half the story and clinics should consider video logs to better show the movement and dynamic results of a treatment. We need to be able to restore harmony of the moving, expressive face and, for this, we need a moving reference point. While new regulation is never going to be quick and easy to implement, I believe standardised photography is a vital step forward for our industry and every practitioner must do their best to ensure that their photographs are as consistent as possible. It will help us as medical professionals to communicate an achievable outcome with patients, while improving transparency within the relationship and creating a clear record of the patient journey.
Disclosure: Dr Emmanuel Elard is the founder of Next Motion, photographic technology for aesthetic clinics.