The Future Of Before And After Pictures
Dr Emmanuel Elard and Dr Per Heden exposes the secrets of good clinical photography and new coming advanced technologies.
Before and after pictures are extremely important for aesthetic practitioners, but unfortunately they do not always realise this. It is in fact, impossible to describe appearance in an objective way without high quality pictures.
When informing patients about potential treatment options it is well known that “conversion” from interest in a procedure, to actually deciding to go through with it is much higher when a patient has seen pictures of their face—rather than having a consultation in front of a mirror.
Pictures are important to educate patients, but not only that; the aesthetic practitioner also learns and develops by evaluating their results from pictures. Pictures are also vital in the discussion with patients who are disappointed about their results, and if any litigation is entered into, good illustrative images can be extremely important. Some practitioners may also be in need of excellent result documentation for use at lectures during congresses.
Getting a perfect before and after picture can be extremely difficult without good knowledge of basic photography. Once photographs are taken, they still may need to be sorted, edited, and put into post-production. Some practitioners delegate this time consuming job to assistants, others may take pictures by themselves with varying degrees of success. But how can we improve what we do?
How we can improve our pictures
We must admit that doctors are not professional photographers and many before and after pictures do not do justice to practitioners’ work. Many mistakes are made, and one of the most common relates to lighting: using the flash when taking an “after” shot. Flash erases shadows in a photograph and creates a fake treatment. The same way, other parameters such as white balance, exposure, patient and camera positioning can be used to cheat and easily distort reality. Knowledge of these parameters is the best start to improve photography skills and do justice to results with transparency, in order to gain patients trust.
Lighting is probably the most important parameter that we need to master. Aesthetic injectors know that we need to restore balance between lights and shadows. Light alone can change our perception of reality, especially when we use fillers: treating dark circles is nothing more than pushing forward the recess under the eyes in order to remove the shadows. To get two perfectly comparable pictures, ambient light must be always the same, and light must always come from the same direction. Use of flash should be avoided as it erases shadows on the patients’ face. Instead, use continuous lighting, like video LED lamps set up with the same intensity and temperature, in the same position for every picture that is taken.
Patient and camera positioning
Once the lighting has been mastered, it is important to think about properly setting up patient positioning—it must be exactly the same in the before and after images.
A small positioning difference can trick reality, especially when we need to showcase results of the lower part of the face. We can ask a patient to bend their head down by a few millimetres in the before picture and raise it up few millimetres in the after picture to show a wonderful fake treatment of the jawline.
In the same way, the camera must be set up in exactly the same position when shooting before and after pictures. The angle of the camera can easily trick the before/after picture when showcasing treatments such as lip augmentation or breast lifts.
Mastering white balance
White balance is a camera setting that adjusts according to lighting in order to make white objects appear really white in the photo. Most of the time, when two pictures have been shot at different times of day, they won’t show the same colours because the ambient light is not the same.
The sensor of the camera is tricked, showing an excess amount of yellow or blue tones.
The best way to correct the white balance is to use a white card, in order to show the camera sensor the true white, and help to adjust the proper colours.
The power of videos
Anyone can be a photo-editor these days, and therefore it can sometimes be difficult for patients to trust before and after images. It is possible to cheat with a photo, but it’s impossible to do the same with a video.
Moreover, a video shows your patients expressions which are more relevant than a picture because practitioners don’t treat static photographs, they treat real patients. Patients who smile, kiss, express themselves—this is what practitioners need to show in order to gain trust. How can you demonstrate to a patient scared by a toxin procedure that results will be perfectly natural? Show a before and after video.
My passion for photography combined with observations about mistakes made taking standardised before and after treatment pictures, pushed me to develop a tool that allows creation and edition of standardised before and after videos of patients simply, and in less than one minute.
I called this tool Next Motion.
This new concept is really powerful because with a video you can, for the first time in our field, also capture the emotions of your patients. By making a positive or negative expression, you are now able to show how well the treatment has worked.
To achieve this, a motorised device piloted by a smartphone allows its camera to make a video while it rotates around the patient. Circular movement around the patient is really important because it is the only way to standardise the position of lights and shadows on the face of the patient, before and after the procedure.
Interaction with the screen of a smartphone running the dedicated Next Motion app, allows us to do things that are impossible to do with a professional reflex camera and is the only way to perfectly standardise your before and after videos:
- Position of the patient can be exactly the same via the patented GHOST MODE ® • White balance and exposure can now match perfectly through the live view mode
- Position of the camera of the smartphone (height and angulation of the phone ) Next Motion is also a complete web-based solution dedicated to improve your workflow and develop your business.
All the contents shot with the smartphone are uploaded into a medical secure cloud, meaning the data is accessible from anywhere through the Next Motion connect portal, on any device connected on internet. Doctors, assistants and also patients have their own personal secure access. With Next Motion connect, doctors now have a powerful solution to help them digitalise their entire practice.
Through medical files of their patients based on the pictures and videos recorded
- They can find your best procedures with keywords and use their database as a powerful video portfolio to convert new patients
- Digital consent forms: iPad pro can display consent forms that will automatically fill with data of the day and patient’s name. Patients can sign it directly on tablets
- Digital traceability: all products used can be photographed through the Next Motion app and will be automatically added in the file of the patient treated
- Electronic prescriptions can be signed from a tablet or a smartphone
- Sharing functionality: all the data can be shared (or not) with your patients, who can access it through their personal web access.
From static 3D…
We have good news: the ‘brain’ of the solution is your smartphone, making your investment a one time buy.
With Next Motion, we ensure you will always be at the cutting edge of the technology that smartphones can offer: generation after generation, being up to date is as easy as downloading the last version of the app.
Until now, all the tools available on the market offer a static 3D modelisation through a known process called photo-grammetry: the doctor takes three pictures from different angles then software processes these three images to create a 3D modelisation. The user experience can be long and tricky—after taking pictures, the SD card must be removed from the reflex camera and data must be transferred to a specific program running on a PC with specific software.
A video shot with Next Motion is equal to hundreds pictures taken around the patient, so it is possible to extract a few snapshots from different angles in the video to turn into 3D. Without knowing it, our customers are also creating 3D while they shoot before/after videos of their patients.
This incredible feature will be soon available for all our existing Next Notion doctors, and will be retro-compatible with all videos shot from the very first one!
In October 2016, Apple has released the iPhone 7+, the first smartphone that has two cameras on the backside: each camera has its own focal—a wide angle (28mm) used to shoot landscapes and a teleobjective (56mm) dedicated to shoot portraits.
One year later, during the WWDC 2017, Apple’s engineering team revealed that the latest version of iOS allows activation of these two lens simultaneously in order to shoot in 3D. This process is called ‘depth mapping’ and works for all iPhones equipped with two lenses (iPhone 7+, iPhone 8+ and iPhone X).
…to the era of dynamic 3D
Last November, Apple released the iPhone X, introducing a new module called ‘True Depth’, using a new disruptive technology. Instantly, we are now able to get an accurate 3D modelisation of the face, or any other part of a body, using a projection of 30,000 infrared lasers on the face combined with an infrared camera.
The True Depth module in action is able to measure the distance of each point projected, and gives an instant 3D modelisation of the face.
A true depth camera used with Next Motion and iPhone X, will allow its users to get an instant static 3D modelisation before and after any treatment. This technology can also measure distances and differences of volumes regarding the injected areas without any process other than using the smartphone.
Moreover, true depth technology, allows us to go farther with 3D. Now we can process up to six modelisations of the face per second, unlocking the possibility to get, for the first time in the world, a dynamic 3D mapping of the face—a similar technology to motion 3D without any need for sensors or powerful computers.
The powerful applications of dynamic 3D
Turning 3D to dynamic means that we will now be able to precisely measure the amplitude of each muscle contractions after a toxin procedure. It will also be possible to precisely follow the movement of any volume after a full aesthetic procedure combining fillers and lifting.
Augmented reality (AR) and artificial intelligence combined with Next Motion technology
Considering it is possible to precisely track all the areas of the face, it is now possible to show ‘live’ through the true depth cam- era, all the results expected directly on the face/body of our patients instead of using static 3D simulations. Combined with AR glasses, the doctor can use the Nextmotion app, and we will soon be able to show live mapping of the best points we need to inject (like the MD codes®) in order to improve each area on the face of our patients.
AR glasses to introduce the concept of the ‘Augmented Aesthetic Doctor’
Augmented reality is powerful, and could be very helpful in bringing safe procedures to our patients. We will soon be able to display live through AR glasses worn by doctors, all the danger zones where a cannula should be used instead of a needle, or display by transparency an anatomic model showing muscles, fat and vessels directly on the face of the patient they are operating on. This futuristic and game changing tool will bring doctors a deep knowledge of anatomy, helping them to better understand what they are doing with their patients.
Clinical studies and deep learning
A cloud based solution like Next Motion Connect offers the possibility to propose to all our doctors to be a part of a global portal of lead clinical studies.
Any doctor from the Next Motion community will be able to use the portal to propose a new clinical study with specific inclusion criteria. On the other side, all the Next Motion doctors connected to this portal, and following patients matching the inclusion criteria can be proposed by the system to be included in the clinical study.
With Next Motion Connect, it will be possible almost instantly find a massive number of patients to lead powerful multi-centre clinical studies and show the efficiency of treatments.
The same way, data collected through dynamic 3D analysis can be a really useful deep learning tool in order to analyse how doctors use products, and better understand how aesthetic products we use in cosmetic and plastic surgery interact with our patients.
All this amazing technology is planned to be released in the next two years on the aesthetic market. Our teams of engineers work hard to improve the Next Motion solution, listening continuously to doctor’s feedback in order to build the whole solution from the inside.
After all, Next Motion is a solution created by a doctor for doctors.
Dr Per Hedén is an Associate Professor in Plastic Surgery at the Karolinska University, the founder and partner of Akademikliniken, one of Europe ́s largest private plastic surgery hospital, where a world leading experience in the use of anatomical cohesive silicone breast implants has been gathered. He is also an inventor of a new fat grafting technology for simplified segmental fat grafting and an author of several international textbook chapters on this subject.
Dr Emmanuel Elard is a medical doctor specialising in aesthetic medicine. In addition, he is an entrepreneur, founding Next motion, a doctor-friendly solution of standardised before and after video creation, editing and sharing, with a digital management system to share with his peers. Dr Elard is a holder of a state Diplomas (IUD) in mesotherapy, in morphological medicine, anti-ageing and injectable tech- niques. He is a member of several scholarly communities, including the AFME, SoFMAA, SFM and LED Academy.