Adherence to Photographic Standards: A Review of Plastic Surgeon Websites

Purpose:  To evaluate the use of photographic standards by practicing plastic surgeons as published by the American Society for Plastic Surgery (ASPS) and the Plastic Surgery Educational Foundation (PSEF).  The Photographic Standards in Plastic Surgery were published in 2006 to assist plastic surgeons in professionalism, privacy, operative planning, and documentation of pertinent anatomy without distortion or distraction.  Adherence to ASPS/PSEF photographic standards was assessed and is presented here. 

Methods:  The 2010 ASPS membership roster contains over 4700 members.  In order to limit the number of members to those which are more likely to host a website, we utilized the 2010 American Society for Aesthetic Plastic Surgery, Inc (ASAPS) roster of 2600 members.  Ten percent of these were randomly selected.  Non-ASPS members, international members with the exception of Canada, members without websites, and those without images of interest were excluded, leaving 122 (4.7%) member websites.  Standard views of breast augmentation, abdominoplasty or rhinoplasty images were reviewed.  If present, the first and last set of before and after images were evaluated for focus, framing, positioning, presence of uniform background, absence of cast shadow, absence of clothing, absence of jewelry, use of photo garments and exposure.

Results:  None of the 122 websites were in complete adherence with the evaluated ASPS/PSEF standards.  Evaluation of all 2180 images demonstrated individual category adherence ranging from 39-87%.  Specifically, adherences of individual categories of all images were as follows: uniform background 87%, in-focus 85%, absence of jewelry 81%, correct exposure 76%, no cast shadow 67%, correct positioning 65%, no clothing 62%, and correct framing 39%.  Photo garments were used in 43% of abdominoplasty images.

Conclusion:  We observed that images frequently deviated from ASPS/PSEF standards.  The categories with least adherence were framing, positioning, the presence of clothing and cast shadow. Surprisingly, 15% of images were out of focus. Uniform adherence with ASPS/PSEF standards will help distinguish accredited plastic surgeons, promote professionalism, reduce errors, and provide appropriate documentation. Accessibility to photographic standards and guidelines should be facilitated.  Additionally, plastic surgeons should continue to update themselves on photographic standards, review their websites, and strive for adherence with those standards.