The “selfie” photo
“Selfie” photos on a smart phone have caused an increase in consultations for facial plastic surgery procedures. Particularly, patient’s are seeking rhinoplasty, nose job, surgery because they are displeased with the appearance of their noses. A “selfie” photo is typically a close-range photo taken by the person themselves on their smart phone camera. People need to be cautioned about what they are seeing in the photo may not be the most accurate portrayal of the reality. Smart phone camera’s use wide angle lenses and either ambient lighting or a poor flash to capture photos. Wide angle lenses distort images by creating what is referred to as a “fish-eye” distortion making images appear wider than they are in reality. Dr. Bared cautions any patient who presents with the complaint of how their noses appear in photos either taken with a smart phone or a point-and-shoot camera as these both cause “fish-eye” distortion especially if taken within close ranges.
Proper photography and lighting
Proper photography and lighting is essential in the appropriate evaluation of a rhinoplasty patient. Ideally, photography limits distortion from the reality. To achieve the appropriate portrayal of the nose a high quality, macro lens should be utilized. Macro lenses have only one glass prism limiting the diffraction of light through the lens onto the digital image. They provide the most significant clarity in digital photography. The patient should be positioned in a standardized fashion and certain angles need to be evaluated. At a minimum, a frontal view, three-quarter view (from both sides), profile view (from both sides), and a base view should be taken. In the frontal view (view of patient directly facing the camera), the patient’s head should be level and parallel to the ground. The photo should be taken at eye level with the patient. The photo should be limited from the top of the head to the neck as this ensures a standardized distance. Lighting is essential. The goal of lighting is to limit the amount of shadowing on the nose. Shadows should not be cast on either side of the nose as this will distort the appearance of the nose. Ideally, a double light source flash is placed at 45 degree angles to the patient to limit shadowing. The profile views and three quarter views need to be taken from both sides of the nose as this with help reveal any inherent asymmetries to the nose. The profile views need to be standardized in that the patient should not have their head tilted up or down but rather just parallel to the ground. The photographer uses the anatomical landmarks of the lower part of the eye and the ear to ensure that proper head tilt. The base view is very important for the surgeon’s analysis of the nose. It reveals nostril asymmetry, deviations, and the shape of the tip. Dr. Bared performs all his own photography to ensure that it is properly performed. He utilizes an analysis of the photos to supplement his physical examination of the nose and develop the appropriate surgical plan.
Dr. Bared utilizes computer imaging as a means of communication with his patients. He finds that this is a helpful tool in showing the patient what their nose may look like as oppose to simply showing them before and after photos of other patients. Computer imaging is just that, however, imaging. It is not to be mistaken as a guarantee of the outcome. It is the best guess as to how the nose may appear after the normal swelling related to surgery has mostly subsided. Computer imaging is a computer program which allows for the ‘movement’ of a two-dimensional photo. It best conveys the profile view as this view is more apparent on a two-dimensional medium. In contrast, the frontal view changes are difficult to convey as the frontal view is a three-dimensional image portrayed on a two-dimensional photo. From the imaging, the patient is able to convey their goals and Dr. Bared is able to ascertain if these goals are realistic given the patient’s anatomy.