Rhinoplasty Photography: Lighting from Above Improves Visualization of Deviations and Irregularities

Importance: Standard lighting with two flashlight diffusors for pre- and postoperative photography deviates from typical natural lighting and may mask relevant irregularities and deviations of the nose due a decreased contrast. Objective: This study aimed at testing the hypothesis that lighting from above improves the depiction of irregularities and deviations of the nose. Design, Setting, and Participants: This was a prospective randomized controlled trial at an academic tertiary medical center. Forty consecutive rhinoplasty candidates who requested a correction of irregularities or deviations of the nose were photographed first with standard anterolateral lighting (two studio strobe lights and diffusor boxes) and second with lighting from above. Ten lay judges rated the degree of irregularity or deviation of the nose on cropped images of the anterior view of the nose with both lighting conditions on a 5-point Likert scale. Results: Ratings for deviation or irregularity of the nose were higher for the photograph taken with lighting from above in 30 (75%), equal in 3 (7.5%), and lower in 7 (17.5%) of 40 pairs of photographs. The mean rating of nasal deformity for lighting from above (2.47; confidence interval [CI]₉₅: 2.22-2.72) was significantly higher than mean rating for anterolateral lighting (1.86; CI₉₅: 1.61-2.11). Conclusions and Relevance: Photographic documentation for rhinoplasty may be improved by including lighting from above if the standard lighting fails to adequately depict nasal irregularities or deviations.