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Facial Distortion With Smart Phone Photography: The Implications For Patient And Surgeon Perspectives
Colton Boudreau, MSc1, Alison Wong, MD, FRCSC2, Anna Duncan, MD1, Margaret Wheelock, MD, FRCSC1.
1Dalhousie University, Halifax, NS, Canada, 2Johns Hopkins University, Baltimore, MD, USA.

Purpose: Smartphones have become ubiquitous and people are now more likely to take photos of themselves rather than have photos taken of them. Additionally, surgeons are now using smartphone cameras for before/after photographs. This has had an effect on self-perception and perception of body features in before/after images, resulting in a growing number of patients seeking aesthetic procedures based around such perceptions. The difference in optics and processing that occurs with smart phone cameras compared to traditional professional cameras has not been thoroughly investigated. As such, this study aims to highlight differences in facial feature measurements with two of common smart phones and a standard DSLR camera.
Methods: Standardized photographs were taken at a professional studio by a professor of photography. A female model was seated ahead of a grey backdrop and a photography boom locked the various cameras at average human armlength (75 cm) from the models face. The camera was positioned at level (0) with the model's nose or, to simulate various selfie angles, 75 cm from the nose at an angle of 30 above or 30 below level of nose. Five cameras were compared including Nikon DSLR with 22 mm lens, iPhone 8 front/back cameras and Samsung Galaxy X7 front/back cameras. Three photos were taken with each camera in each of the aforementioned positions. An exposure meter was used to standardize imaging conditions between camera types. Cephalometric measurements using carefully predefined anatomical landmarks were obtained from each of the photographs using imageJ software. Ratios of six vertically oriented and four horizontally oriented cephalometric measures of each image were calculated (ie. nose height over medial forehead height). The average ratio value for each camera was compared holding the DSLR as standard to assess for differences using student t-tests.
Results: Based on comparison to DSLR, the following distortions were determined. ↑ implies increased ratio at stated photograph angle (p<0.05); ↓ implies decreased ratio at stated photograph angle (p<0.05).

Vertical RatiosPhiltrum/ChinMedial Forehead/NoseLateral Forehead/NoseMedial Forehead/Lateral ForeheadMidface/NoseMidface/Medial Forehead
iPhone Front↑ (0)
↓ (-30)
↑ (0)
↓ (+30)
↓ (-30)
↑ (0)
↓ (+30)
↓ (-30)
↑ (0)
↓ (+30)
↓ (-30)
↓ (+30)
↑ (-30)
iPhone Back↓ (-30)↑ (0)
↑ (+30)
↓ (-30)
↑ (0)
↓ (+30)
↓ (-30)
↑ (0)
↓ (+30)
↑ (0)
↓ (-30)
↓ (0)
↑ (-30)
Samsung Front↓ (-30)↑ (0)
↓ (+30)
↑ (-30)
↓ (0)
↓ (+30)
↓ (-30)
↓ (-30)↑ (-30)
Samsung Back↑ (+30)
↓ (-30)
↑ (0)
↑ (+30)
↓ (-30)
↑ (0)
↓ (+30)
↓ (0)
↓ (+30)
↓ (-30)
↑ (0)
↓ (+30)
↓ (-30)
↓ (0)
↓ (+30)
↑ (-30)

Horizontal RatiosLip width/Mandible WidthNasal Base Width/ Lower Midface WidthInterpupillary Width/Upper Midface WidthForehead Width/Upper Midface Width
iPhone Front↓ (-30)
iPhone Back↓ (0)
Samsung Front↑ (-30)↓ (+30)
Samsung Back↑ (0)↑ (0)↓ (0)

Conclusions: In general, both tested smartphones display significant distortions when taking selfies at level and above/below face, compared to DSLR. Most distortions are noted in vertical features of the face with the general trend of central facial features appearing smaller than peripheral features. Horizontally oriented features tended to be less effected at all angles. Trends were generally similar between phone brands with subtle differences. This suggests that smartphone cameras have inherent distortions that are likely resultant of different hardware optics and also inherent software-based corrections. We propose there may be an over-correction of the typical "fish-eye" effect of smartphone lens leading to relative decreases in central facial features compared to peripheral. Awareness of these distortions are important for surgeons to consider when patient requests are based around smartphone photographs.


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