Digital Photography in Plastic Surgery

Sir:FigureWe read with great interest the article by Sanniec et al. entitled “Adherence to Photographic Standards: A Review of Plastic Surgeon Websites,”1 and we agree with the authors that photographs are essential in a plastic surgeon's practice. Although several articles have been published on this subject, medical publications/presentations and Web sites continue to appear that fail to satisfy clinical photography standards.2 These images are valuable for various purposes, including the following: creating models for preoperative planning, providing visual references during surgery, assessing surgical outcome, sharing data and experience with colleagues, communicating with patients to clarify their treatment plan, educating residents, and preparing presentations and publications. Moreover, photographs should be an integral part of the patient clinical record, in addition to informed consent, because they could represent one of the few elements of a physician's defense in medicolegal issues. In fact, today, most plastic surgeons, at some point in their career, have to address a complaint filed by a patient about their clinical performance, which may be followed by litigation. Because of the increasing importance of photographs, standardization according to well-established criteria is necessary to obtain significant and comparable images to be used in lawsuits. Very small variations can cause notable changes and may decrease markedly the value of clinical photography.3 Maintenance of constant camera settings, lighting, accurate positioning of subjects, no post–image acquisition changes using computer software, and use of identical views and patient preparation will significantly increase standardization.4 On this topic, in 2007, our group published an article in the journal Aesthetic Plastic Surgery entitled “Digital Photography in Plastic Surgery: How to Achieve Reasonable Standardization Outside a Photographic Studio.”5 In this article, on the basis of the medical literature and our own experience, we reported general criteria concerning patient preparation and camera setting and specific criteria for accurate image capture within different anatomical areas. The aim of our letter is to emphasize the importance of digital photography for plastic surgeons during medicolegal litigation; emphasize that plastic surgeons should use standardized photographic criteria; and raise awareness about some criteria, published in 2007 by our group, that we currently use in clinical practice. Use of strict digital photography guidelines that control all image characteristics will significantly enhance the potential of these images to objectively illustrate the plastic surgeon's work. Achille Aveta, M.D. Angela Filoni, M.D. Paolo Persichetti, M.D., Ph.D. Plastic Surgery Unit, University Campus Bio-Medico of Rome, Rome, Italy DISCLOSURE The authors have no financial interest to declare in relation to the content of this communication.