Basics of Face Photography For Esthetic Dental Treatment

132-142_MEDEIROS:129_SHOR_v5 2/12/10 10:04 AM Page 132
Basics of Face
Photography for
Esthetic Dental
Treatment
Dudu Medeiros, BFA, MBA1
Oswaldo Scopin de Andrade,
DDS, MS, PhD2
Fabiana Varjão, DDS, MS, PhD3
T
he smile is one of the most significant
contributors to facial esthetics; there-
fore, the appearance of the teeth has
a dramatic effect on both an individual’s at-
tractiveness to others and his or her self-
image. For many years, record keeping for
dental treatment was limited to intraoral
photographs for scientific observation.
Nowadays, extensive media coverage has
increased public awareness of the benefits
of cosmetic dentistry, making it necessary to
keep photographic records of more than
just the mouth. A “perfect smile” releases
patients from inhibition, worry, and tension,
which is a treatment result that intraoral
photographs cannot capture. Thus, an ad-
ditional photographic record is necessary:
face photography.
1
São Paulo, Brazil.
2
Director, Advanced Program in Implant and Esthetic
Dentistry, Senac University, São Paulo, Brazil.
3
Assistant Professor, Case Western Reserve University
School of Dental Medicine, Cleveland, Ohio, USA.
Correspondence to: Dudu Medeiros, Rua Maestro

Elias Lobo, 1020 no. 32, São Paulo, Brazil 01433-000.
Email: dudu@dudumedeiros.com.br
© 2009 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY. NO PART OF THIS ARTICLE
MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER.
Basics of Face Photography for Esthetic Dental Treatment
When performing esthetic dental treatment, espe- 1. Equipment

cially in cases involving significant changes to the pa- 2. Aperture and shutter speed
tient’s smile, initial and final face photographs are 3. Studio
essential aids for evaluating esthetic improvements to 4. Production
the overall appearance. Face photographs are also 5. Photographic sequence
useful for determining a patient’s satisfaction with the 6. Artistic photography
new smile. 7. Image consent form
A professional photographer may be hired for the
photo shoots, but it is worthwhile for clinicians to
learn how to take these photographs themselves.
Mastering photographic techniques improves visual EQUIPMENT
perception, because the camera gives us the ability to
highlight portions of the environment that we may not The camera body, lens, and memory card are the pri-
have perceived otherwise. This development of per- mary parts of a camera. Point-and-shoot cameras
ception may help with the development of clinical have coupled the lens to the body but do not offer
skills. The ability to provide excellent treatment and enough optical quality for intraoral or face photogra-
also to record the results of that treatment is the best phy. However, proper knowledge of the basic princi-
way to confirm and advertise the quality of one’s ples of photography allows for the achievement of
work. Treatment images can be used for patient edu- acceptable results even when simple equipment is
cation in the office as well as for publications or pre- used.
sentations.
The purpose of this paper is to instruct dental prac-
titioners on the basic principles of face photography Camera Body
as an additional stage of esthetic treatment.
Digital cameras are presented with a wide and some-
times confusing range of options. How do we choose
which camera to buy, and in what ways do they differ?
BASIC PRINCIPLES With so many different cameras available and new
OF FACE PHOTOGRAPHY models being announced every few months, it is not
possible to make specific recommendations on which
Face photography for dentistry can be classified into one brand is best.
two main categories: the initial and final photographic Digital single-lens reflex (DSLR) cameras are often
records. The initial photographic record is taken to preferred because they allow the user to choose from
provide the clinician and patient with evidence of the a variety of interchangeable lenses. DSLR cameras
initial situation. The final photographic record is used have functions that allow for an accurate preview of
to show the improvements, limitations, and esthetic depth of field, generating high-quality images. There
changes accomplished by the dental treatment. A are basically three types of DSLR camera bodies:
common mistake is for the initial photographs to be entry level, advanced amateur, and professional. They
taken without any production or studio lighting, while differ from each other in terms of weight, resistance,
the final photographic record is performed in a pro- and price. DSLR entry-level and advanced amateur
fessional photographer’s studio. It is crucial that the camera bodies allow for appropriate photographic
initial and final photographic records are captured images, showing adequate resolution, dynamic range,
using identical lighting, production, make-up, back- and color depth. Professional cameras have outstand-
ground, and camera settings to generate a realistic ing resolution, dynamic range, color depth, detail,
assessment of the dental treatment. and sharpness for intra- and extraoral photographs.
Seven elements should be considered to master The rugged body also provides superior resistance to
the photographic technique: humidity and dust. However, because of the high
QDT 2010 133

MEDEIROS ET AL
Fig 1a Face photograph taken Fig 1b Face photograph taken with Fig 1c Face photograph taken with a
with a wide-angle lens (9 to 49 a standard lens (50 mm). telephoto lens (> 50 mm).
mm).
cost, professional cameras are an investment that it is Lenses

only justified if the practitioner has an intimate rela-
tionship with photography. Lenses are the eyes of the camera. There are three basic
camera lens types: standard, wide angle, and telephoto.
The 100- or 105-mm telephoto lenses are the most indi-
When buying a DSLR camera, do not forget to cated for dental photography because of their accuracy
research the appropriate flash options for intra- and minimal distortion. Examples of photographs taken
oral photographs. Usually, any body and lens with different types of lenses are shown in Fig 1.
work for face photography. Entry-level photo- A simple exercise can help clarify the difference
graphic equipment is acceptable for both intra- among lenses. Keep one eye closed for a few mo-
oral and face photography. However, as the user ments, and that is the image a 50-mm lens (standard)
advances in photographic skill, an advanced or would produce if you were looking through the cam-
professional body is preferable. era. When the eye is opened again, the field of vision
becomes larger, which mirrors the sensation of using a
134 QDT 2010

wide-angle lens. Now, keep one eye closed and curl The pixels can be stored in the memory cards as
your fingers so that when looking at the thumb side of RAW, JPEG, or TIFF files, depending on the options
your hand you can see a small point of light. Look offered by each camera. JPEG files are the most indi-
through the opening and focus on small parts of an cated for use in the dental office or presentations. For
object. You are now looking through a telephoto lens! printing purposes, TIFF files are indicated and re-
For dental photography, the telephoto lens must quired by most publishers.
have a macro function (also named micro depending
on the manufacturer) so that the same lens can be It is preferable to have two 8-GB cards instead
used for face and intraoral photographs. Another sim- of one 16-GB card. Having a second card handy
ple exercise can aid our understanding of the macro means that you will be able to continue using
function. Close one eye and position your index fin- your camera in case the other card becomes de-
ger in front of your face. While looking straight at the fective. After you have downloaded the images
finger, slowly move it toward your eye and stop when to your computer, format the card to delete old
the finger is out of focus. You have found the focal data. And most important, remember to put the
distance of your eye. If your eye had a macro function, card back into the camera!
you would be able to see your finger in full detail
even when it was very close to your eye.
The biggest investment for the dentist should be in
the lens. The camera body may eventually become APERTURE AND SHUTTER SPEED
dated, but the lens will still work with accuracy for any
type of body as long as they are from the same manu- Aperture and shutter speed are the essence of pho-
facturer. tography. Mastering these two variables is the most
important step in understanding the basic principles
When choosing the lens, opt for well-established of face photography.
brands to assure its compatibility with future Aperture (diaphragm, f-number, or f-stop) is de-
equipment. fined as the system that regulates the amount of light
that passes through the lens and records the image
on the camera’s memory. It can be compared to a
Memory Card window that allows light to enter a dark room. Shutter
speed is a setting that controls the length of time the
The camera’s memory, once represented by photo- shutter is open, allowing light through the lens. A
graphic film for analog cameras, is now represented wider aperture requires a shorter shutter speed to cor-
by memory cards, which will record the image in pix- rectly expose the image in the camera; a narrower
els. Pixels can be compared to puzzle pieces that aperture requires a longer shutter speed.
when put together form an image. The pixel count of Imagine three faucets with different diameters, in
currently available DSLR cameras ranges from 6 to 30 which the water flow is 1 L, 2 L, and 3 L per second.
MP. Now imagine that you want to collect 30 L of water.
How many pixels do we need? A good way to ex- To obtain the same 30 L you would have to leave the
amine this issue is to compare the size of the largest first, second, and third faucets open for 30, 15, and 10
print you can make from each camera. If a 10 MP seconds, respectively. In photography, the 30 L of
camera is used, a 10.7 ⫻ 16-inch image can be water represents the image you want to record in your
printed. The same image with the same quality can be memory card, the faucets with different diameters are
printed at 15.2 ⫻ 22.8 inches if a 20 MP camera is the lens aperture, and the time they remain open is
used. While pixel count is worth considering, it is not the shutter speed. The same result can be obtained
the only or even the most important factor, because even though variable aperture and shutter speed are
the accuracy of the photograph is provided primarily used.
by the type of lens used. For the dental office, a 6 MP The aperture is represented by the letter f. The f-
camera is sufficient. number sequence frequently observed in the camera
QDT 2010 135

MEDEIROS ET AL
Clinical ex-
amination
revealed
that both
arches ex-
hibited at-
rophy with
mobile tis-
sue and
limited
vestibular
form. Fur-
ther analy-
sis revealed
compro-
mised sup-
port as a
result of ex-
tensive
residual
ridge re-
sorption of
A
Fig 2a This
59-year-old image
male was produced
presented to thewith aper-
clinic with both
Fig 2barches.
With an aperture of f/2.8, only the red
ture f/32. Note that even though the red stone is in focus, with the background out of
maxillary and mandibular edentulism and in- A panoramic radiograph revealed an edentulous at-
stone is the primary focus, the background is focus. The depth of field is significantly re-
ability
alsotocompletely
wear conventional
in focus. prosthetics (Fig rophic maxilla with
duced; therefore, pneumatized
the area around the posterior
red segments
1). His chief complaint was difficulty in chewing. He re- stone became blurred. For face photography,
and an edentulous mandible with a limited amount of
an aperture above f/16 should be used to
quested a long-term solution with functional and es- supracanal bonedetails
capture sufficient heightofinthe
thepatient’s
posterior areas (Fig 2).
face.
thetic prostheses. His medical history was noncontrib- Study casts were mounted on a SAM 3 (SAM,
utory with the exception of hypertension. Münich, Germany) fully adjustable articulator, and the
interarch distance was determined. A diagnostic set of
maxillary and mandibular complete dentures were
completed with a trial tooth arrangement (Fig 3).
Based on the patient’s edentulous situation and medi-
CLINICAL PLANNING PHASE
cal history, several treatment plans were composed.
lens is: f/2, f/2.8, f/4, f/5.6, f/8, f/11, f/16, f/22, f/32. nism of the studio strobes, and varies between 1/125
Since the f-number represents a fraction of the aper- and 1/250 seconds.
ture, the higher the f-number, the lower the aperture.
Different apertures allow the background to be in
focus, totally out of focus, or somewhere in between.
Therefore, choosing the f-number is essential to gen- PHOTOGRAPHY STUDIO
erate a precise depth of field (Fig 2).
The shutter speed is measured in fractions of sec- There are many types of lighting in photography, and
onds. Some examples of shutter speed numbers a photography studio usually allows the photographer
(from fast to slow) are as follows: 1/4000, 1/2000, to control every aspect of the lighting. A complete
1/1000, 1/500, 1/250, 1/125, 1/60, 1/30, 1/15, 1/8, photography studio has several different types of
1/4, 1/2, 1, 2, 4, and 8 seconds. For face photogra- light, such as soft light, hard light, hair light, and back-
phy, the shutter speed usually follows the synchro- ground light. Some photographers use flash to refer
136 QDT 2010

Figs 3a to 3c Photography studio equipment: (a) studio strobe; (b) umbrella; (c)
soft-box.
3a 3b 3c
Fig 4 Soft-boxes positioned 45 degrees to the patient’s face.
to small battery-operated flashes and strobes to refer much more powerful than off-camera flashes, allowing
to the large units plugged into a wall socket for the use of an aperture above f/11 for a satisfactory
power. Studio strobes (Fig 3a) are the most indicated depth of field.
for face photography in dentistry, and can be used For face photographs in which the main objective
with white umbrellas (Fig 3b) or soft-boxes (Fig 3c). is to enhance the mouth, the strobes should be posi-
Studio strobes provide lighting or a sudden burst tioned 45 degrees to the patient’s face to lighten the
of light triggered by the camera. They are generally corridor of the mouth (Fig 4).
QDT 2010 137

MEDEIROS ET AL
pressed by the perfection of their techniques for cre-

If there is no room in your office for a studio and ating light and shadow, could be transferred from the
you already use a camera with a circular flash for canvas to the face. The step-by-step make-up se-
intraoral pictures, you can ensure the quality of quence shown here was performed by Mr Ney Garcia.
face photographs by positioning a strobe be- Due to the nature of their profession, dentists will
tween the patient and a white wall. The strobe pay more attention to the teeth when observing a
will whiten the background, creating a cleaner photograph or when talking to an individual. The lay-
and more professional look for the photograph. person, however, will focus attention on the eyes. The
main role of make-up in dental face photography is to
draw the viewer’s attention to the mouth.
PRODUCTION The following step-by-step make-up procedures
can be performed by a hired professional, a dental
It is important to establish precise goals for your pho- assistant, or the patient him or herself:
tographs by asking yourself the following questions:
What do I want people to see when they look at this • Brows: use tweezers to groom the brows, respecting
picture? What is the main subject of the image? their natural shape.
Production is defined as the preparation phase be- • Skin: apply foundation with a make-up brush and
fore the actual photo shoot is initiated. The use of ade- spread evenly across the face (Fig 5a).
quate lenses and light conditions does not guarantee • Imperfections: apply concealer under the eyes and
the quality of the image. Many elements can interfere where necessary to conceal red spots or blemishes,
with the final result. The eyes, nose, hair, earrings, col- and spread with a make-up sponge, brush, or fin-
lars, etc, can catch the viewer’s attention while the gertips (Fig 5b).
main subjects of the photograph, the mouth and • Powder: apply translucent powder with a large pow-
teeth, remain unnoticed. der brush, sweeping around the entire face (Fig 5c).
The powder takes away the shine but leaves a
healthy sheen and may be used for all types of skin
Clothing and Accessories from fair to dark.
• Eyes: apply white or pearl brightening shadow
Here, less is more. The main goal is to eliminate any under the brows and brownish shadow across the
competition with the mouth. Simple clothes with a clas- lids (Fig 5d).
sic cut, few details, and light colors work well for that • Cheeks: blush should be applied with a medium
purpose. Jewelry should be avoided, although small and blush brush on the apples of the cheeks to provide
delicate earrings are allowed if they will help the patient a healthy appearance (Fig 5e). The most indicated
feel more comfortable. Glasses should be removed be- tones are orange-ish.
cause the strobes will be reflected in the lenses. • Lashes: clear mascara does not compromise the
make-up result in case it smudges, although it may
be substituted with brown or black mascara (Fig 5f).
Hair • Lips: lipstick can be applied with a lip brush for a
more homogenous finish (Fig 5g). Medium or dark
The hair must not interfere with the face. Long or ex- lip colors enhance the beauty of the teeth better
travagantly styled hair should be put up in a ponytail, than light colors.
or a hair band may be used.
A male patient will not use the same type of
make-up as will a female. However, make-up
Make-up should still be used on male patients to subtly
camouflage blemishes or imperfections and re-
If Leonardo da Vinci and Michelangelo were alive duce the shine of the skin.
today, they could be make-up artists. Their talent, ex-
138 QDT 2010

5a 5b 5c
5d 5e 5f
Step-by-Step Make-up Procedures
Fig 5a Foundation is applied with a make-up brush.
Fig 5b Concealer is applied under the eyes and on blemishes.
Fig 5c Translucent powder is applied with a large brush.
Fig 5d Brightening shadow is applied under the brows.
Fig 5e Blush is applied with a medium blush brush on the apples of the
cheeks to provide a healthy appearance.
Fig 5f Clear mascara is applied to the lashes.
Fig 5g Lipstick is applied with a lip brush for a more homogenous finish.
5g
Comparison Between Initial and Final Photographic Records
Figs 6a to 6c Initial photographic records of the patient’s smile: (a) right side, half profile; (b) frontal
view; (c) left side, half profile. Note that the eyes are level with the camera.
Figs 6d to 6f Final photographic record with patient positioned exactly as in the initial record: (d)
right side, half profile; (e) frontal view; (f) left side, half profile.
PHOTOGRAPHIC SEQUENCE During the photo shoot, take the initial pho-
tographs even if the patient does not feel comfortable
The initial photographic record must be made before smiling. This type of embarrassment reflects the social
any dental intervention is performed. The initial discomfort of having an unpleasant smile. Often, pa-
record is definitely the most important one, because tients get used to the changes in appearance caused
while final photographs can always be retaken, the ini- by the dental treatment and forget what they used to
tial images cannot. Before starting the treatment, look like. Comparing the initial and final photographs
make sure the initial photographs are acceptable and is fundamental to remind patients of the evolution of
that backups have been saved. the dental treatment and help them to better appreci-
A very common mistake, perhaps influenced by re- ate the final results.
ality makeover shows, is a lack of care when taking The following sequence of angles is suggested for
the initial images, as if they are not as important as both initial and final photo shoots: frontal, half profile
the final ones. Since the goal of face photography is (right and left sides), and full profile (right and left
to highlight the improvements following treatment, sides) (Fig 6).
the initial and final photographs should be taken
under the same conditions of light, production, and
angle to allow practical comparisons.
140 QDT 2010

Figs 6g and h Left profile: (g) initial photographic record; (h)

final photographic record.
ARTISTIC PHOTOGRAPHY the images in printed publications such as dental

magazines, journals, textbooks, and websites, as well
Once you master the basic techniques, allow yourself as in presentations. The document should also state
to play with different angles and elements. Slight that copies of the images may be stored in computer-
changes in make-up, such as different lipstick colors, ized records.
draw attention to the smile (see photograph on first
page of this article). Unusual accessories, sponta-
neous smiles, decorative elements such as fruits, etc,
can enhance the artistic photographs. CONCLUSION
The artistic photo shoot is a powerful way to ad- Understanding the many new concepts presented in
vertise. Select the patient’s best picture and this paper may seem overwhelming. However, the
offer it in a frame as a gift. A beautiful picture in main objective of this paper is to provide basic infor-
a beautiful frame, exposed to friends at home or mation that can be used by practitioners to enhance
colleagues at the office, will show your work to and value their work as dentists or technicians. As is
the world. true for all dental procedures, face photography re-
quires technique, motivation, and patience. With
time, excellence can be achieved, thus enhancing
both personal satisfaction and professional success.
IMAGE CONSENT FORM
An image consent form is a document signed by the
patient or guardian giving the right and permission ACKNOWLEDGMENTS
for the photos to be published or shown in presenta-
tions. The authors dedicate this article to Dr Adauto de Freitas. They
wish to thank make-up artist Ney Garcia for suggesting and exe-
Because of variations in the legal systems around cuting the make-up step-by-step sequence, Marcelo Jun Kunisawa
the world, there is no standard template for a consent (DOACOMM) for his graphic support, and Dr Sérgio Siquiera Jr,
clinical professor, Advanced Program in Implant and Esthetic Den-
form. The consent form should be prepared by a law tistry, for the clinical treatment of the patient.
office according to the legal system of one’s country.
In general, the authorization should state the use of
QDT 2010 141

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132-142_MEDEIROS:129_SHOR_v5 2/12/10 10:04 AM Page 132

Correspondence to: Dudu Medeiros, Rua Maestro

Basics of Face Photography for Esthetic Dental Treatment

When performing esthetic dental treatment, espe- 1. Equipment

QDT 2010 133

cost, professional cameras are an investment that it is Lenses

134 QDT 2010

Basics of Face Photography for Esthetic Dental Treatment

QDT 2010 135

136 QDT 2010

Basics of Face Photography for Esthetic Dental Treatment

Fig 4 Soft-boxes positioned 45 degrees to the patient’s face.

QDT 2010 137

pressed by the perfection of their techniques for cre-

138 QDT 2010

Step-by-Step Make-up Procedures

Fig 5a Foundation is applied with a make-up brush.

Fig 5b Concealer is applied under the eyes and on blemishes.

Fig 5c Translucent powder is applied with a large brush.

Fig 5d Brightening shadow is applied under the brows.

Fig 5f Clear mascara is applied to the lashes.

Comparison Between Initial and Final Photographic Records

140 QDT 2010

Figs 6g and h Left profile: (g) initial photographic record; (h)

ARTISTIC PHOTOGRAPHY the images in printed publications such as dental

QDT 2010 141

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