Evaluating the 20-year evolution of photographic standards in plastic surgery: a comparative analysis

Standardised photographic documentation is essential in plastic surgery for clinical and academic use. ASPS guidelines outline strict standards, but advancements in technology, particularly smartphones, may have influenced adherence. This study evaluates adherence to photographic standards in breast and face photography from 2000 to 2020 in major plastic surgery journals. A total of 1,752 articles from three major plastic surgery journals in the years 2000 and 2020 were reviewed. Breast photographs were assessed based on patient positioning, arm positioning, background, clothing, and jewellery/watches, and framing, while face photographs included camera angle, patient positioning, background, clothing, makeup, hairdo, mimic, jewellery, and framing. Two independent reviewers scored adherence using a binary scale, with interrater reliability assessed via Cohen's kappa. Trends were analysed using least square means and paired t-tests (p < 0.05). Among 504 photographs, only 11.9% met all standards. Significant declines were observed in clothing (p < 0.001) and jewellery/watches (p < 0.001) for breast photography, and in photographic sectioning for face photography (p = 0.002). Improvements were noted in posing (p < 0.001), hairdo (p = 0.028), and framing for breast photography (p = 0.015). Adherence to photographic standards has declined in key areas, underscoring the need for reinforced training and technology-driven solutions to ensure professional documentation.