Summary: In 1998, DiBernardo et al. published a very helpful standardization of
comparative (before and after) photographic documentation. These standards prevail
to this day. Although most of them are useful for objective documentation of aesthetic
results, there are at least 3 reasons why an update is necessary at this time: First,
DiBernardo et al. focused on the prevalent standards of medical photography at that
time. From a modern perspective, these standards are antiquated and not always correct.
Second, silver-based analog photography has mutated into digital photography.
Digitalization offers virtually unlimited potential for image manipulation using a vast
array of digital Apps and tools including, but not limited to, image editing software
like Photoshop. Digitalization has given rise to new questions, particularly regarding
appropriate use of editing techniques to maximize or increase objectivity. Third, we
suggest changes to a very small number of their medical standards in the interest of
obtaining a better or more objective documentation of aesthetic results. This article
is structured into 3 sections and is intended as a new proposal for photographic and
medical standards for the documentation of aesthetic interventions:
1. The photographic standards.
2. The medical standards.
3. Description of editing tools which should be used to increase objectivity. (Plast
Reconstr Surg Glob Open 2017;5:e1389; doi: 10.1097/GOX.0000000000001389; Published
online 17 August 2017.)