title: Evaluation of Photographic Variables in Patients with Indication for Facial Rejuvenation.
abstract: Photography standardization is paramount for appropriate critical analysis of aesthetic surgery outcomes. Therefore, the authors designed a study to evaluate the influence of different variables in photos of patients with indications for undergoing facial rejuvenation.
  
  
  
  This blinded prospective study was conducted by the Section of Plastic Surgery in the Hospital das Clínicas at the Federal University of Paraná. In the study, 29 patients had their photos taken in two separate settings. Photo 1, termed "preoperative" (Pre), was obtained according to the same pattern for all patients. Photo 2, termed "postoperative" (Post), was acquired on the same day using different variables to manipulate the photo outcome. No surgery was actually performed. Both photos (Pre and Post) were sent to five experienced Brazilian plastic surgeons, who provided a score for photo 2 that varied from -10 to +10 compared with photo 1.
  
  
  
  The photos were examined by 119 plastic surgeons. No significant improvement was observed in most of the groups, except for the group that used a flash for the Post photography (p = 0.035). Almost half of the scores (45.37 %) were above zero. The highest score was found to be ten for two photographs of the makeup group. A score of zero was assigned to 54.62 % of the photos, which means no changes occurred between the Pre and Post photos.
  
  
  
  Inadequate photographic technique can change assessments of photos in a meaningful way. All the factors evaluated had a positive impact, but the only statistically significant variable was the use of a flash in the Post group.
  
  
  
  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 .
authors.affiliation: Hospital de Clinicas da, UFPR, Rua General Carneiro, 181, Alto da Glória Curitiba, Curitiba, PR, 80060-900, Brazil.
authors.forename: Isis Raulino
authors.initials: IR
authors.lastname: Scomação
authors.forename: Ruth Maria
authors.initials: RM
authors.lastname: Graf
authors.forename: Ivan
authors.initials: I
authors.lastname: Maluf
authors.forename: Antonio Jorge
authors.initials: AJ
authors.lastname: Forte
authors.forename: Renato
authors.initials: R
authors.lastname: da Silva Freitas