Quantification of faults resulting from disregard of standardised facial photography.

Medical photography is an important part of documentary procedures in plastic surgery both for quality assurance and for protecting surgeons from possible medico-legal claims filed by patients. Photo documentary standards were established to make photos reliable and to enable comparisons between pre- and post-operative views of a patient, different operative procedures and between results achieved by different surgeons. Despite their obvious importance, especially in the documentation of subtle surgical procedures on the face such as rhinoplasty, photo documentary standards continue to be disregarded. In this article, we analyse and quantify faults caused by even small deviations from photo documentary standards. Photos of 10 healthy, young adults (n = 10) taken in accordance with established standards were compared to photos with the similar types of faults in positioning of the head (±10° deviation from the standard), camera angles (±10° deviation from standard) or mimic expression (slight smile). A computer-assisted facial analysis was performed and the effects of faulty photo documentation on the final result were calculated. The analysis showed, for instance, that a +10° fault in positioning of the head causes a mean shortening of the nasal dorsum by 32.34% (p<0.001) and of the front by 15.33% (p = 0.001), whereas the chin is elongated by 6.82% (p = 0.004). A -10° fault elongates the nasal dorsum by 11.93% (p<0.001) and shortens the upper lip by 22.50% (p = 0.007) and the chin by 13.67% (p = 0.001). Deviations from standardised camera angles lead to similar mistakes, but to a lesser extent. A mistake in mimic expression leads to a shortening of the upper lip by 23.20% (p = 0.006) and also to a clear cheek lift. We show that slight deviations from photo documentary standards result in dramatic faults in the final outcome.