Cosmetic Dermatology Photography - Lighting, Backgrounds, Shadows and More

rofessional-level patient photography is fundamental to the success of aesthetic clinics. For providers of cosmetic dermatological services where incremental or subtle improvements in skin need to be accurately and concisely captured, documenting basic changes and improvements is insufficient-- client images must be sharp and polished. Effective photographs can offer your practice a range of benefits, such as:

• Treatment planning
• Documentation of facial and anatomical features
• Pre and post-procedural comparisons
• Teaching and Education

Fortunately, today’s mobile devices (iPhone, iPad, Tablet) offer quality that is comparable to that of a professional level DSLR camera, but with the ease of using a phone or tablet. As a result, more and more service providers are moving towards capturing patient photographs with their mobile device, allowing flexibility with respect to where the patient is photographed. If you want to learn more about DSLR cameras in comparison to mobile devices with regard to plastic surgery photography, you can weigh up the benefits and disadvantages here.

One critical issue to be aware of, however, is observing HIPAA compliance if you are using a mobile device to take client photographs. The simplest way to ensure that you are HIPAA compliant is to use a service that stores photos in an HIPAA-compliant cloud server for you. This way, photographs taken are automatically stored on the cloud but never on the device itself. Read more here about achieving HIPAA compliance in your clinic.

1The critical importance of lighting in your exam room

The importance of consistent, bright illumination and an evenly-lit space cannot be emphasized enough. The lighting in client photographs must be maintained to ensure uniformity, particularly if you are capturing images prior to and following procedures. Inconsistent lighting can veil or obscure treatment progress.

The effect of outside light.

Although the photographic quality and capacity of the new generation of mobile phones and devices is outstanding, there is one thing they cannot control, and that is the lighting in a room. The lighting in a room is immensely affected by the natural light outside, and the intensity of that natural light which changes between the morning and afternoon. Colors fluctuate and appear warmer in the early morning or late afternoon light due to the low angle of the sun.

If you photograph a patient in the morning, and their next photo is taken in the afternoon, the photographs will be significantly different, impacting on the uniformity of the images. There are three ways to maintain consistency in photographs despite changes in outside light.

Nair, A. G., & Santhanam, A. (2016). Clinical Photography for Periorbital and Facial Aesthetic Practice.
Journal of Cutaneous and Aesthetic Surgery, 9(2), 115–121. http://doi.org/10.4103/0974-2077.184047
Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4924408/

Be scrupulously consistent in the times you photograph. However, this is not always realistic or feasible with busy schedules and clients who require flexibility in their appointment times

Convert a windowless room in your office into a dedicated photography room, thus eliminating any alterations in natural light which will affect the photograph. However, in a busy office with high movement of patients, there could be logistical issues with multiple clients requiring photographs at the same time.

Purchase a blackout shade. For minimal investment, blackout shades provide maximum return. Blackout shades create conditions that mimic a photography studio by providing maximum light blockage and consistent lighting. Each consulting room can easily be fitted with blackout shades, thus creating multiple rooms suited to taking patient photographs. Blackout shades can be purchased here.

Сolor temperature.

Color is measured in units called degrees Kelvin, and is integral to achieving successful and consistent lighting. Light bulbs that produce yellow, ambient light have a color temperature of around 2700k. While perfect for landscape photographs, it is unsuitable for clinical photographs, as it gives the subject warm overtones and distorts the skin tone.

As color temperature increases from 3,000K, the color of the light appears yellow and more white. Temperatures over 6,000K are referred to as cool colors (the photograph will appear to have a bluish-white tinge). The color temperature of daylight varies, but is often in the 5000K to 7000K range.

A color temperature of 5000K is ideal for medical photography as it gives the perception of daylight with white light, capturing subtleties and details in the photograph with clarity.

Source: LED Color Chart. Retrieved from
http://www.epanorama.net/newepa/2011/12/23/fundamentals-led-color-chart/

Setting up optimal lighting.

Excellent, studio-quality lighting does not happen by chance. The best photographs are a product of careful manipulation and consideration of light sources to achieve a well-illuminated image . Lighting can come from five main light sources:

Overhead lights. If you rely on overhead lighting in your clinic as your main light source, be aware of the degree of Kelvins of your light bulbs (you will need a color temperature of 5000K or more). Also, endeavor to have a light fitting that broadly disseminates light: the broader the light source, the more even the light illumination, which helpfully fills in shadows.

Also be aware that the closer the light source, the softer the light. Photograph patients as close as possible to the source of overhead light. The closer the patient is photographed to a light, the broader the light source in relation to the subject, and the patient’s features will be well-illuminated. Consequently, the further the patient is from the overhead light, the dimmer the light in the photo will be.

However, overhead lighting is paradoxical in that proximity to the light source also increases the likelihood of shadows occurring. The light is brightest on the upper aspects of the person’s head, which creates shadows under the nose and chin as the light falls over the face. Balancing these two variables can be challenging, and for this reason, having an additional source of light or lights on the patient is invaluable: it will eradicate shadows and brighten the image. Read below to find out more about auxiliary or supplementary sources of light.

Speedlights:

(such as this one) are larger light units that can be used to flood the photograph with even white light, ideal for clinical photographs. Speedlights provide both an enhanced and more abundant source of light in your photographs, providing the quality of light you would expect to find in a professional studio. Speedlights can be easily synchronized to your iPhone for straightforward use: see here.

Speedlights are best used in conjunction with diffusers to help make the light appear softer and more natural in the image.

Ring lights

Are a photographic tool commonly used for portrait photography that disseminate uniform light (in a ring shape) from the camera. A flash tube is wrapped around the camera lens.They are an excellent way to achieve even light in images and eliminate shadows, particularly for photographs where the face or skin is being captured.

These days, ring lights are incredibly popular because they can be easily fixed to your iPhone and can dramatically improve the quality of lighting with minimal fuss. They can also be used with a diffuser to soften the light as it is emitted from the flash.

The flash: Using the flash on your device can overexpose and flush images with bright light, muting subtler details on the skin such as fine lines and blemishes, or variations in skin color and tone. If you need to capture photographs for facial rejuvenation or resurfacing procedures, it is best to avoid using a direct flash when taking the photo. Soft, diffuse and even lighting will allow you to capture facial redness and pigmentation.

In most cases, the flash should be used as a last resort, only used for dark corners or if specific lighting is really needed in a particular area.

Softboxes/diffusers

Diffuse the flash of a ring light or speedlight, converting the harsh light from the flash into a broader, softer, more even light. Furthermore, softboxes reduce shadows. Unfortunately, softboxes are not appropriate to use with overhead light sources, and can take up space. Softboxes can be purchased here.

2Setting up your space to achieve the perfect lighting

Setting up your space to achieve the right lighting is paramount. The ideal set-up to photograph a subject should be structured the following way:

http://www.popphoto.com/gallery/top-10- photography-lighting- facts-you- should-know#page- 2

• A blue, grey or black backdrop (see notes on selecting the perfect background below).
• A position marked on the floor, or a floor mat for the client to stand on.
• The device set up directly in front of the subject. You could use a portable stand to fix the position of your iPad or iPhone.
• With respect to additional lighting, there are two options.

Option 1: Softboxes, Diffuser and Flash

Option 2: Ring Light

• a) Attach a ring light to the device. Ring lights offer the quickest and most space-effective method of achieving well-lit images with minimal fuss. Ideally, the light source should be stationed parallel to the subject at the level of the face to flush the photograph uniformly with light. This image presents the ideal set up of a ring light fixed to an iPad.
• b) If using a speedlight rather than a ring light, it is best to use it with a diffuser so the light disseminated is softened.

3Using an appropriate backdrop for your background

If you want to improve the professionalism and focus of any clinical photo, investment in a good quality backdrop can offer incommensurate gains. The background of your photographs should be:

• An even surface
• Neutral
• Non-reflecting (for example, shiny oil-based wall paint provokes reflections in flashes)
• Monochromatic, or one consistent color: ideally, black, grey, or blue

Sheets or drapes are inappropriate as backdrops as the undulations in the fabric show wrinkles and shadows, detracting from the photograph. A common issue that severely affects photo quality is the use of different backgrounds in photos: photographing a client in front of a laser or the wallpaper of the exam room shifts the focus from the patient and the clinical image to the background, which will often also cast irregular shadows.

Standardized backgrounds are simply more professional, more effective, and guarantee uniformity in your photographs. Most digital cameras use a computer weighting system that will focus partially on the subject and partially on the wall behind them, blending the distances and focusing on neither. A neutral background places the camera focus squarely on the patient.

You can purchase white or light blue panels or roll down shades to fix to the back of the door or wall where you take your photographs of clients.

Another effective option is a collapsible chromakey background such as this one. Specifically designed for photography, this backdrop can be hung on the back of a door for when photos are being taken, then neatly and easily stored away when you are not using it.

Background colors The three most appropriate and effective colors to be used for a backdrop are blue, black and gray. Here are the pros and cons of each:

4Eliminating shadows

Shadows are caused by unevenly distributed light, and can obstruct photos and detract from the focus. If you can see a shadow in the viewfinder, you can be assured there will be a shadow in the shot.

• Check for shadows under the nose and neck and reposition the lights if necessary to eradicate them.
• Check for shadows cast on the backdrop: if there are shadows, these can often be eliminated by moving the subject further away from the backdrop. Twelve inches distance between subject and backdrop is recommended to minimize these shadows occurring.

The use of an additional flash unit with your iPhone or iPad can make a tremendous improvement to the lighting in the quality of the photographs you take if your office has dark corners, shadows or a lack of natural light. Used in conjunction with soft-boxes, you can almost entirely eliminate any shadows or at least dramatically minimize them.

5Attention to detail

Unsurprisingly, the smaller and seemingly inconsequential details also figure in successful clinical photography. Paying attention to the way in which the patient’s hair, makeup and jewelry impact on the photograph will help ensure you achieve more standardized and competent images.

• Hair should be tucked away or tied back in such a manner that no facial features are obscured. Any stray strands of hair need to be pinned away from the face, or tucked behind the ears. Having some hair clips, ties or bobby pins on hand can be useful.
• Make-up should be removed prior to the photograph, particularly for patients who have undergone dermatological procedures. Obviously, make up will obscure any gains or improvements made as a result of laser resurfacing, microdermabrasion or skin rejuvenation treatments.
• Jewelry can be distracting and detract from the focus of the photograph; it should be removed.
• Garments or accessories such as brightly colored scarves that impact on the visibility of the area being photographed should also be removed prior to the patient’s photograph being taken. In addition, such pieces can affect the uniformity of images that show response to treatment over time: as much as possible, strive for consistency across the series of photographs that you take.

6Pixels

Pixel is a contraction of the term picture element. It is the smallest element of a digital image, as digital images are composed of tiny squares, similar to a tile mosaic on a kitchen wall. Although digital photographs appear to be smooth and continuous, they are in fact a composition of millions of tiny squares or pixels.

An iPhone camera that boasts 10 megapixels means that each photograph has ten million tiny squares in it. As a result, an image of 10 megapixels will be more detailed and nuanced than a photograph of three megapixels, for example. The iPhone 7 has a sophisticated 12 megapixel camera, whereas the iPhone 6 has an 8 megapixel camera. The iPad Pro boasts a 12 megapixel camera, meaning that photographs of faces will be incredibly clear and detailed.

Upgrading from an iPhone 6 to an iPhone 7, or purchasing the iPad Pro, can significantly improve the quality and sharpness of the photographs you take.

7Mobile device - Digital Zoom vs DSLR - Optical Zoom

Mobile phones and devices are equipped with digital zoom. DSLR cameras, however, boast optical zoom. Unfortunately, the difference between the two is that optical zoom trumps digital zoom every time. Optical zoom uses a range of lenses to make it possible for the photographer to see an object in the distance as if it were closer. As these lenses are mechanically complex, they cannot be compacted to fit in a thin smartphone body.

Smartphones and devices are fitted with digital zoom, which is quintessentially a zoom that blows the image up without actually focusing in or adding more detail. As a result, the image becomes more blurry and appears pixelated. For this reason, using zoom on a mobile device is inappropriate for taking medical photographs as the quality and precision of the image is compromised. It is better to get closer to the subject to capture detail if necessary.

However, change is afoot: the iPhone 7 and iPhone 7 Plus have two lenses at different magnifications, allowing for some zoom with sharper images. This is not true optical zoom, but nonetheless a definite advance for digital cameras.

Conclusion

Capturing professional photographs of your clients requires measured consideration of the elements that will impact on the composition of your image.

For clinics that do not have the luxury of a dedicated photography room, the addition of several inexpensive tools can go a long way in improving your client images. Purchasing a collapsible chromakey background, blackout shades for windows and a ring light will dramatically improve the quality of your photographs.

It may take some effort in the beginning, but setting up your office space so it can quickly and effortlessly be transformed into a photography studio to accurately and consistently track your clients’ progress is an incredibly worthwhile investment, which ultimately, will serve to benefit you by improving your business.