Critical Need to See Photographs for Plastic Surgery

Photographs and videos are critical tools of Plastic Surgery to document problems of contour, function, and deformity. Pictures and moves can also demonstrate the results of the procedure. Photos can detail the quality of the result and record the recovery path it takes to get there. The question is how is this best done, and how do you evaluate the quality of such details?

Over my long career, I have seen a great number of patients unhappy after surgery done elsewhere. The most common factor is that they complain that they never could get to see what that surgeon's work was like. This is the problem of hand waving with words alone about our profession. Drawings alone, bedside manner, and verbal descriptions just do not complete the picture for establishing patient education for realistic expectations. There has been just so many patients over the years who have come to me angry over other doctors hiding just what their results are like. I get many such patients from some parts of the world with doctors who supposedly tell these patients that they are not permitted to put any of their patients' pictures up on the Internet.

Evaluation of Surgeon Skills

Evaluation of The Surgical Sculptor

Plastic Surgery as surgical sculpture is best documented with images and how the sculpture moves. This is a critical component of evaluation of just how good an artist we are talking about. Whether you are trying to evaluate an artist or a technique in general, seeing examples of the problem and result are key to understanding if something works. Try to get into the evaluation of a Michelangelo sculpture without pictures of the piece from different angles or a Leonardo da Vinci painting without the photograph. With surgery there is an added element of how it feels, and beyond that there is the emotional component, and what path that patient needed to take to get there.

Documenting Deformity

Documenting the Deforming Problem with Pictures

Talking about deformity is just not the same as experiencing it. So much can be hidden with words alone. Seeing how something looks and moves is so much more critical for documentation than hoping for the best with vague details. Photographic Principles

Guiding Principles for Photographs

Accurate Documentation
Each photograph of a surgical sculpture is the actual contour and has not been modified to misrepresent the problem or what has been done.

Typical Results
I have designed my website so that my patients can tell me that their experiences were close to or better that what they found on my web pages. Although no surgeon can guarantee results, they are typical for my patients and my sculpture. Not all surgeons have the same skills nor use the same techniques. Do not assume what you see here is what any other surgeon will achieve.

Consent
Every patient on my website has provided consent for use of their images.

Time Frame
When possible, the time interval before and after surgery results are specified.

Standard Photographs and Movies

Standard Pictures and Movies

In my analysis of the Plastic Surgery literature, many articles just did not demonstrate the full reality of the sculpture. When only one or two views are shown, the full nature of the contour changes or how the structures moved are not demonstrated. I was seeing patients unhappy after surgery done elsewhere and some of those patients were done by surgeons writing these papers, some were actually the cases presented, and others were patients shown on those doctor's web sites. Why were these individuals unhappy?

Evolution of Standard Pictures and Video
Standard Views permit me to better understand a problem I am evaluating. I was seeing patients from around the world. How could I better minimize their travel to Virginia and yet arrange a high probability for that patient to be able to set up a tentative surgery based on an evaluation before they came to the office? Did the in office examination of the patients differ from the remote assessment? This led to the subdivision of several Standard Pictures to sub groups for different aspect of problems.

Different Needs By Body Region, Sex, and Problem
Different parts of the body require different standard images. There is also a variation by sex and if loose skin is a factor. When a part moves, animation issues of how that part looks in reproducible actions needs to be demonstrated. Female Breast Reduction Pictures were adapted to Standard Pictures for Gynecomastia Male Breast Reduction. These were then further subdivided into dealing with loose skin issues of Male Mastopexy Standard Pictures for Loose Skin of the Male Chest and then Standard Revision Gynecomastia Pictures and Male Chest Scarring to better understand scar issues seen after prior surgery. Standard Videos for Gynecomastia & Male Chest Contours was the ultimate critical tool for evaluation, but this is beyond the average user, so I saw very few of this format. However, when I did, they were great in understanding the problem. Women with sagging skin had other issues that led to Standard Photographs for Sagging Female Breasts.

Standard Photographs Instructions

Female Breast

Male Gynecomastia Chest

Abdomen

Otoplasty Standard Pictures For Evaluating Ears

Photos for Evolving Surgery Technique

I then wanted to better understand just how good my methods were at addressing the problem. What was happening? What could I or my team do to improve the results? And, then were the changes in technique actually an improvement? This included the actual photographic documentation and adding important extra views to demonstrate problems I was seeing from my techniques and unhappy patients asking for help after surgery done elsewhere.

Photos for Recovery and Emotional Healing

Photos For Recovery and Healing Expectation

Additional views early after surgery with this critical documentation method also demonstrated the path taken by each patient. I could analyze the recovery, bruising, and healing. Analysis of early results enabled my surgical technique evolution.

reviewing photos before surgeryIn my office, each patient could compare seen results in the mirror with their before surgery pictures.

By posting such images on the Internet, they had a better understanding of what typically happens after surgery. This lowered anxiety of what to expect for recovery. Patients were instructed to call me immediately if their results were not similar such that I could intervene and help.

Patient Education influencing recovery with documentation.

Path to Recovery Education

By completing a set of documentation before and during healing, we were able to show the typical path taken by our technique and method. Swelling, bruising, and pain all tend to show up under such critical methodology. I would turn each documentation session into a learning experience for my patients asking them to learn to listen to their bodies give feedback as to how far they can push the injured part before it was sending feedback to stop. If someone claims they have a technique with less swelling, bruising, and faster mobility, such skills should be able to be documented. Our patients were given a tool to judge how their progress compared to typical patients I had done before. They were instructed to call me immediately if not on this path.

Picture Presentation galleries with simple views and then click to see more.

Picture Presentation and Organization

Pictures need to be organized for effective evaluation. To best understand any patient, there must be a collection of Standard Views. Collections such as Gynecomastia Picture Galleries permit a particular problem to have a few views organized so that the viewer can see the many forms of this condition. On this site, each gallery image is a link to the more complete patient picture sets. How that patient healed photos are extended information on the evolution of tissues for that individual's recovery. This is way too much information for general trends. There are also Gynecomastia Bruising Swelling Recovery Galleries to show trends for that sculpture across various patients and problems. Procedure Pictures and videos permit a more detailed look at what happens during that surgery technique.

Technique for Taking Pictures

Techniques for Taking Pictures

  • Looking At the Whole Picture
  • Consistent
  • Lighting
  • Framing
  • Positioning
  • Contour continues around the body
  • Lens Distortion
  • Use Unchanging Body Anatomic Features
    • Frame After Photo
    • Match Before After
  • Parts Body Do Not Change:
    • Bone & Weight Loss
    • Unoperated Regions
    • Scars - Moles

How to Evaluate Pictures is an ongoing project. Different deformities and parts of the human body require different techniques for photographic evaluation. Function is the issue. How can pictures or videos best document how that part moves and functions is the issue.

One such section is about Gynecomastia Male Breast Reduction.

How to Evaluate Gynecomastia Pictures and Movies of the Male Chest

How to Evaluate Otoplasty Pictures of the Ears

How to Evaluate Tummy Tuck Pictures and Videos of the Stomach

How to Evaluate Pictures

Photographs Fail to Show Certain Issues

How Tissue Moves
Photos are still snapshots of the subject and do not demonstrate motion as well as video. Flexing muscle still photos can demonstrate some deformity, but not as effectively as the videos as seen in this case of an Extended Crater Deformity after Revision Gynecomastia Surgery done by New York surgeon. In looking at the still pictures, the results almost look acceptable. The flexing muscle views do show some of the problem. Take the time to look at the videos of that example and the devastating nature of the deformity is revealed.

How Tissue Feels
We all have scars. Healed tissue tends to be firmer, not as pliable as uninjured structures. Some of the dynamic component can come through refined pictures, but how the tissue is to touch it just is not shown well. I do not have any way that I have discovered to quantitate or document this aspect.

Tissue Sensation
Injured nerves can have less sensation. Photographs do not show the pain, sensitivity, numbness, or hypersensitivity of this sculpture. Other methods are available for quantification, but can be tedious to measure.

Structure Function
Can sometimes be documented with pictures. However, this documentation can be difficult to obtain such as refined hand finger function, breathing or smelling through the nose, hearing, areola or nipple contraction and relaxation, or urine flow stream. Having a great looking nose that remains completely obstructed is not as successful as surgery that addresses both issues. Some of these issues can be addressed with creative pictures or videos asking the patient during a Tummy Tuck Patient's Video Discussion of her recovery and surgery experiences.