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Editorial
. 2022 Sep-Oct;85(5):V-XIV.
doi: 10.5935/0004-2749.2021-0318.

Photodocumentation in oculoplastic surgery: an up-to-date overview

Juliana Senna Figueiredo Barbi  1 , Izabela Camargos de Figueirêdo Neves  1 , Patrícia Mitiko Santello Akaishi  2 , Ricardo Morschbacher  3 , Julián Espinosa  4
Affiliations
Editorial

Photodocumentation in oculoplastic surgery: an up-to-date overview

Juliana Senna Figueiredo Barbi et al. Arq Bras Oftalmol. 2022 Sep-Oct.
No abstract available

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Conflict of interest statement

Disclosure of potential conflicts of interest: None of the authors have any potential conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Suggested positioning of the patient and physician, with the patient seated on a swivel stool with no wheels and a floor mat with footmarks for the front, oblique (45°), and profile positions. The camera, preferably mounted on a tripod, must be aligned to the patient’s face with the external flash directed at the ceiling, and a white diffuser reflector attached to the body of the flash was used (white side not visible). The first photo must be taken with the patient holding a 18% gray card so that if any adjustment to the white balance is necessary, the card can serve as a reference in the photo editing software.
Figure 2
Figure 2
Primary position gaze (PPG). The camera’s thirds grid was used so that the upper horizontal line passes through the pupils and the apex of the patient’s ears. Oblique position (O). The patient is requested to rotate the entire body to 45° until the tip of the nose aligns with the malar eminence and the ear apex with the lateral eyelid canthus. Lateral view framing (L): it is important to align the ear apex to the lateral eyelid canthus and only the same side of Cupid’s bow can be seen.
Figure 3
Figure 3
Eyelid photography. The upper photographs demonstrate the preoperative state of a blepharoplasty, primary position of gaze, right and left oblique, and lateral views. Below, the same views in the third postoperative month were taken to demonstrate background, patient positioning, framing, and lightning standardization.
Figure 4
Figure 4
Ptosis photography. This was performed with a frontal flash to demonstrate the margin reflex distance. The first row shows the preoperative state from left to right: primary position of gaze, supra, and infraversion. The second row shows the same views, after instilling one drop of 10% phenylephrine into the right eye, as marked with an “X” above the ipsilateral eyebrow. The third row corresponds to the same views in the sixth postoperative month after a right levator aponeurosis reinsertion with a posterior approach.
Figure 5
Figure 5
Orbit photography. These photographs demonstrate the views for orbital pathologies. In the upper left, a primary position of gaze (1), and in the upper right, the chin was lifted to demonstrate proptosis. (2) Other photographs demonstrate ocular motility in infraversion (3), infralevoversion (4), levoversion (5), supralevoversion (6), supraversion (7), supradextroversion (8), dextroversion (9), and infradextroversion (10).
Figure 6
Figure 6
Photography in dynamic wrinkles of the face. This figure illustrates the pre- (first horizontal row) and post- (second horizontal row) state of botulinum toxin treatment. From the left to the right of the reader, the treatment of procerus and corrugators is demonstrated, patient makes an “angry face”; treatment of the frontal muscle, the patient “raised her forehead”; treatment of the orbicularis muscle (periorbital wrinkles), the patient smiled and showed the right and left oblique, respectively.
Figure 7
Figure 7
Macrophotography. These images illustrate how one can take photographs of small lesions in the periocular region using the same flash (without the need for another flash suitable for macrophotography). Thus, the focus should be placed on the manual, with a focal plane of 0.38 m, a magnification ratio of 1:1, f/11 aperture, shutter speed of 1/200, ISO of 200-400 and flash in the TTL mode directed backward with light reaching in this case, a 30-cm silver reflector. Note from the photograph of the lesion, it was possible to obtain details of the lesion without losing the portrayal of three-dimensionality since the photo was taken with bounced light.
Figure 8
Figure 8
These two photographs reproduce a common error when a smaller frame of the patient’s face is desired (“magnification”). In the left photo, a 100-mm lens at 3 m from the patient was used. As it is a telephoto lens, the lens allows for the enlargement of the image and a smaller field of view, that is, the same as distancing and using the “zoom” of smartphones and compact cameras. In the right photo, we place a 35-mm lens (“normal” lens for a camera with an APS-C sensor) and brought the camera close to the patient’s face to try the same framing as that of the previous photo. Note how the second photo creates distortions on the patient’s face, with enlargement of the middle third of the face, mainly the base of the nose, an effect that can be called “Christmas ball” because it resembles the view that one can have of the face when looking at a mirrored Christmas ball.
Figure 9
Figure 9
A common error when using the flash. The left photograph was taken with an external flash bounced on the ceiling, and the right photo was taken with an external flash directed straight at the patient’s face (frontal flash). Note how relief (such as the apparent fat pockets of the lower eyelids), shadows (such as the nasojugal groove), and wrinkles and skin marks are more clearly shown in the first photograph. In the second photograph, the frontal flash “flattens” the image, removing the idea of three-dimensionality and favoring the patient in the sense of disguising skin wrinkles and pigmentations, which is not suitable for medical photographs in which one wishes to show the face with all its natural features.
See this image and copyright information in PMC

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