Dynamic Video–Photograph Studio: A New Rhinoplasty Documentation — Suleyman Tas PubMed

1 23 Aesthetic Plastic Surgery

ISSN 0364-216X

Aesth Plast Surg DOI 10.1007/s00266-020-01673-7 Dynamic Video–Photograph Studio: A New Rhinoplasty Documentation David Safaryan, Sofia Santareno & Süleyman Taş

1 23 Your article is protected by copyright and all rights are held exclusively by Springer Science +Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery. This e-offprint is for personal use only and shall not be self-archived in electronic repositories. If you wish to self-archive your article, please use the accepted manuscript version for posting on your own website. You may further deposit the accepted manuscript version in any repository, provided it is only made publicly available 12 months after official publication or later and provided acknowledgement is given to the original source of publication and a link is inserted to the published article on Springer's website. The link must be accompanied by the following text: "The final publication is available at link.springer.com”.

LETTER TO THE EDITOR Dynamic Video–Photograph Studio: A New Rhinoplasty Documentation David Safaryan1,2 • Sofia Santareno1,3 • Su¨leyman Tas¸1 Received: 1 March 2020 / Accepted: 8 March 2020 /C211 Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2020 Abstract Background Photographic documentation of the nose is the standard procedure for many surgeons who perform rhinoplasty across the world. One of the most challenging views in the photograph documentation is the frontal view that requires special photographic skills and may create a bias. Our dynamic video recording process allows us to improve the quality of patient evaluation, making the assessment more convenient and enabling the documenta- tion of high-level rhinoplasty database. Objectives Our main goal was to present our selected video recording process that ensures standardized, high- quality documentation of the data from rhinoplasty patients. As per our knowledge, this tool has not been published before. Methods We have invented a rotational platform-based chair that allows us to make a dynamic evaluation of the patients under standardized photograph settings (patient’s position, camera, and lighting features) through a video recording. Results We demonstrated that the quality of our rotational video recording process is similar to that of standardized photographs. However, this additional dynamic evaluation helps to avoid Photoshop/C210 corrections which may result in bias. Conclusions This high-quality patient evaluation repre- sents advancement in the photograph-documentation pro- cess in the modern era of rhinoplasty. This new dynamic video recording process prevents image misinterpretation, helps improve the quality of patient evaluations, makes the process more convenient, and enables the documentation of high-quality data for rhinoplasty patients. Moreover, this new recording process is an excellent tool for educational purposes and presentations. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. Keywords Photograph /C Video /C Studio /C Rhinoplasty /C Documentation /C Objective /C Evaluation Introduction Standardized high-quality preoperative photograph docu- mentation is critical for surgery planning, comparative postoperative assessment, and postsurgical outcome demonstration after plastic surgery procedures, particularly in the field of rhinoplasty [ 1]. Currently, most plastic sur- geons around the world are using digital cameras to create Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00266-020-01673-7) contains sup- plementary material, which is available to authorized users. & David Safaryan drdavidsafaryan@gmail.com Sofia Santareno sofiasantareno@gmail.com Su¨leyman Tas¸ drsuleymantas@live.com; https://www.suleymantas.com.tr 1 TAS¸ Aesthetic Surgery Clinic, Istanbul, Turkey 2 Plastic and Reconstructive Surgery Department, Central Research Institute of Dental and Maxillofacial Surgery, Moscow, Russia 3 Department of Plastic Surgery at North Lisbon Hospital Centre, Lisbon, Portugal 123 Aesth Plast Surg https://doi.org/10.1007/s00266-020-01673-7 Author's personal copy

their photographic documentation archive of patients who undergo rhinoplasty; this process is essential for consulta- tion, preoperative planning, and postsurgical evaluation [2]. However, photograph documentation also involves cer- tain limitations that may result in a bias. One such limi- tation is that of lighting setting and its several different views that may be difficult to achieve using a standardized method [3]. Thus, advancements are needed in the photo- graphic tools to overcome these restrictions. In this report, we describe our novel photograph–video studio concept that allows us to ensure standardized, high- quality documentation in a dynamic manner. It is a simple method for achieving complete information about the external nasal anatomy and provides a predictable alterna- tive to motionless photographs that will create a good impression on your patients and colleagues during presentations. Material and Methods We have created a rotational platform-based chair that allows dynamic evaluation of the patient with the use of the standardized photograph studio settings. This rotational platform holds a weight of up to 80 kg and is easily available in the market. The feet of a regular bench are attached to it. This do-it-yourself (DIY) platform is then positioned on the center of the photograph studio in front of a black background at a distance of 1 m from the camera (35-mm photography, 50-mm lenses) [ 4]. The lightening system must be 2 para-flashes arranged each with a 45 8 angle [5] (Fig. 1). The patient, without makeup or jewelry, sits on our platform with a relaxed facial expression. The Frankfurt horizontal line (an imaginary line from the top of the tragus to the infraorbital rim) is used as a guideline, and the patient should be positioned with this line parallel to the ground, at exactly 90 8 from the lens. The video should be taken at the patient’s eye level [ 6]. We press the button, and the platform starts to rotate clockwise at a speed of 1.33 rpm. The recording requires 24 s: 3 /C19/C19in frontal stable view, 13/C19/C19from frontal to the side view, 3 /C19/C19in side stable view, and 5 0’ on the dynamic smile on the left profile [7] (Video 1, Figs. 2, 3). Our study was conducted in accordance with the guidelines of the Declaration of Helsinki. Written informed consent was obtained from all the patients. Results We demonstrated that the quality of our rotational video was similar to that of standardized photographs, as shown in Fig. 3b. It is a valuable tool that prevents the need for Photoshop/C210 corrections that may cause a bias. In Video 1, against its low-quality version to upload to the system, it gives a more accurate evaluation rather than the standard photographs; compare them with Figs. 2, 3 which were taken in our professional photograph studio. The authors consider that the quality of this dynamic evaluation improves the presentation of their clinical cases in meetings of scientific organizations. Further, they believe that this helps our colleagues become a part of a real-time consultation with the patient, increasing their empathy with each clinical case. Fig. 1 The video photograph studio is demonstrated; there is a platform in the middle with a black background and 2 para-flashes system Fig. 2 a The frontal picture from the photograph studio. b The frontal picture from the video studio; this picture was taken as a screenshot from the video. Against it is a simple screenshot for a quality comparison Aesth Plast Surg 123 Author's personal copy

Discussion The goal of photography in rhinoplasty is to attain sharp, clear images that emphasize the fine details of the nasal anatomy [ 8]. A good database enables the surgeons to better access their performance as well as share experi- ences with colleagues during scientific presentations and publications. They also aid clearer patient consultation and are fundamental in surgical planning [ 3]. It is essential for a surgeon who performs high-volumes of rhinoplasty procedures to develop a standardized, reproducible method to achieve high-quality photographs that clearly demonstrate the external nasal anatomy. The standard method must consider [ 9] the following points: • Patient preparation and positioning: hair should not cover the face, the patient should not wear any ornaments or makeup, and the patient should be sitting in a Frankfurt-oriented position [ 6, 10] • Background: black is preferred, because it eliminates shadows and reflections. For dark-skinned subjects, we make simple lighting arrangements [ 11] • Lighting: quarter light system of 2 lights of equal intensity positioned at 458 from the subject-camera axis [5] • Camera features: with 35-mm photography, lenses with a focal length of 50-mm produce the least distortion and provide the largest depth of field to ensure that the whole face is in focus [ 4]. Some authors recommend the use of lenses with 90–105-mm focal length for facial views [ 11]. The 50-mm is our recommendation, because we only need to be 1.1 m away from the patient, while a lens with a focal length of 105-mm needs to be used at a distance of 4.5 m or more. • Camera position: the lens is perpendicularly positioned to the level of the area being photographed, with the patient’s eye oriented. The standard positioning of patients and the photograph views (anterior, profile, basal, oblique, and cephalic) may be hard to attain and offer lack of reproducibility and consistency. The most effective way to address this is with the use of a formal photograph studio, with a trained pro- fessional photographer [ 6, 12]. However, static photographic documentation may also involve a bias, because it is easily changeable by Photo- shop/C210 and becomes an imprecise tool to evaluate the results (who has never questioned about it in someone’s presentations?). In particular, we find it essential to include in the pho- tographic documentation of the nose in two different pro- jections. The first view must include the tip of the nose from below with the patient drawing 45 /C176 , back the head to better document the ratio between the tip shape and the nasal labial angle. The second projection must include the dorsum of the nose from the top with the patient bending the head down (35/C176 ) for better record of the axial deviation. However, in video recording, it is very challenging to precisely control the patient’s head movement, and some distortions may occur; therefore, we have standardized the video record as presented. However, this is one of the limitations of our technique. We may use 3D stereophotogrammetry to calculate the differences in the preoperative and postoperative images; it allows us to objectively assess the postoperative outcomes. These two images are superimposed to estimate the dif- ferences using a color scale or a distance map. However, this method has certain limitations: a 3D camera is a sig- nificant financial investment and may not be cost-effective in private practice; moreover, it is a time-consuming method, and it is difficult to achieve reproducible results [13]. The dynamic video documentation is protected from Photoshop/C210 edition. It warrants no fake postoperative results in presentations. However, it does not enable us to perform preoperative simulation of the expected result. It is not an expensive method but it needs a separate space, even an extra-room. The clockwise rotation on a constant speed attends reproducible results; however, this consists on a unidirectional way. Moreover, this platform has a weight limitation of 80 kg, making it impossible to use in some patients. The senior author has been using the preoperative and postoperative videos for case examples in national and international scientific meetings (8th Annual Meeting of Rhinoplasty Society of Europe, 13th Eurasian Plastic Sur- gery Congress, Brazilian Congress, Caucasian Congress, Fig. 3 a The side picture from the photograph studio. b The side picture from the video studio; this picture was taken as a screenshot from the video. Against it is a simple screenshot for a quality comparison Aesth Plast Surg 123 Author's personal copy

Turkish Rhinoplasty Course, 40th Turkish Plastic Surgery Congress) and has received encouraging feedback from colleagues. In addition, this recording technique may significantly improve the quality of imaging evaluation for other plastic surgeries (rhytidectomy, otoplasty, blepharoplasty, and body contouring procedures) and enable more objective evaluation. Conclusion The process of photograph documentation in aesthetic surgery requires to be revolutionized. Our photograph studio, with its DIY rotating platform, allows dynamic video–photograph documentation, with more precise and objective result evaluation. Another point to consider is that the facial expression of smiling on the profile view also addresses the patient’s satisfaction after the surgery. This has a positive effect on the audience during scientific presentations. As well as when patients see this video, they also review their self-evaluation as in double mirroring. Compliance with Ethical Standards Conflict of interest The authors declare that they have no conflicts of interest, commercial associations, or intent of financial gain regarding this research. Humans and Animal Rights This study was conducted as per the guidelines in the Declaration of Helsinki. Informed Consent Informed consent was obtained from all patients. References 1. Galdino GM, DaSilva D, Gunter JP (2002) Digital photography for rhinoplasty. Plast Reconstr Surg 109(4):1421–1434 2. Karlan MS (1979) Photographic documentation techniques. Ear Nose Throat J 58(6):246–251 3. Sen Z, Kaya B, Serel S, Saglam H, Can Z (2005) Photographic standardization in esthetic surgery. Ankara Universitesi Tip Faultesi Mexmuasi 58:5–10 4. Becker DG, Tardy ME Jr (1999) Standardized photography in facial plastic surgery: pearls and pitfalls. Facial Plast Surg 15(2):93–99 5. Daniel RK, Hodgson J, Lambros VS (1990) Rhinoplasty: the light reflexes. Plast Reconstr Surg 85(6):859–866 discussion: 867–868 6. Swamy RS, Sykes JM, Most SP (2010) Principles of photography in rhinoplasty for the digital photographer. Clin Plastic Surg 37:213–221 7. Sheen JH, Sheen A (1987) Aesthethic rhinoplasty, 2nd edn. Mosby, St. Louis 8. Beekhuis GJ, Rosenbaum JM (1979) Office photography for facial cosmetic surgery. Laryngoscope 89(4):677–681 9. Webber WB (1987) Rhinoplasty: The importance of consistent documentation and significant long-term follow-up. Plast Reconstr Surg 79(4):640–654 10. Jemec BI, Jemec GB (1986) Photographic surgery: standarts in clinical photography. Esthetic Plast surg 10:177–180 11. DiBernardo BE, Adams RL, Krause J, Fiorillo MA, Gheradini G (1998) Photographic standards in plastic surgery. Plast Reconst Surg 102–2:559–568 12. Dolen UC, Cinar S (2016) Perfect lighting for facial photography in aesthetic surgery: ring light. Aesth Plast Surg. 40:319–326 13. Mailey B, Baker JL, Hosseini A, Collins J, Suliman A, Wallace AM, Cohen SR (2015) Evaluation of facial volume changes after rejuvenation surgery using a 3-dimensional camera. Aesthetic Surg J 36(4):379–387 Publisher’s Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Aesth Plast Surg 123 Author's personal copy