Photographic Standards in Plastic Surgery

Two references are helpful: The American Society of Plastic Surgeons Guidelines, published in 2006 is the Standard Reference and Photographic Surgery: Standards in Clinical Photography, Author, Borut, I.E. in Journal of Aesthetic Plastic Surgery, Volume 10, pages 177-180, 1986.

Photography is to Plastic Surgery as water is to a fish. Without it, there is nothing for any clinical detail to find support. Everything sinks into an ocean of explanation. ‘A picture is worth a thousand words’ (or more) should have been coined by a Plastic Surgeon. (it actually appears in a 1911 newspaper article quoting newspaper editor Tess Flanders discussing journalism and publicity, according to Wikipedia). The point is that standardized photography is a necessity not a luxury and part of the standard evaluation of a Plastic Surgery patient before and after any treatment; whether it be a surgical or a non-surgical procedure. If it is important in ‘Plastic Surgery’, multiply the importance by 103 when it comes to Cosmetic or Aesthetic Plastic Surgery which is entirely based on visual parameters. Which is why it is so hard to understand why so many Plastic Surgeons fail to take photographs in the standard positions with a plain background and reasonable lighting, at the same distance, before and after a procedure. It is definitely not rocket-science. Photography and the ability to use a camera is part of the curriculum of a Plastic Surgery Residency Training. It usually merits a Chapter in most standard textbooks of Plastic Surgery. Failing to take adequate photographs along these guidelines falls short of the Standard of Care. It would be like a cardiologist who did not listen to your heart. Not taking photographs at all is probably negligence when it comes to non-reversible procedures with potentially permanent sequelae such as surgery. This would be akin to an anesthesiologist who did not check your vital signs before a general anaesthesic. If I sound impassioned about this it is become I am. Look at before and after pictures on plastic surgery websites and judge for yourself. Good photographs speak to the attention to detail of the operating surgeon. Bad ones, well, I’ll leave that to you to finish the sentence.

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