June 25, 2006

Problem solving with a plastic surgery photography lighting scenario.

I received an email from Dr. Joel Studin in April ’06, where he asked for help in setting up photographic lighting in his examination room at his offices.

Dr. Studin is a renowned cosmetic surgeon based in Long Island, NY and he needs to do specific ‘before’ and ‘after’ photographs of his patients for his records.

But there was a problem – despite guidelines from the plastic surgery society on standardizing photography, the results weren’t consistent, and just didn’t look good.

Fortunately, I was able to help him by applying a few lighting techniques, changes to his camera settings, and some unexpected inspiration …

Firstly, the scenario:
Typical of doctor’s offices, the consulting rooms have limited space, and there just isn’t room to have a dedicated studio area to take the photos of patients. Who can spare the added expense of that anyway? So one of the small consulting rooms have to double up as the area where the photographs are taken, with two studio flash-heads mounted high on the wall.

Here’s a photograph to give you a sense of scale:

That’s Dr. Studin in the doorway there. As you can see from the photographs, there isn’t much room from corner to corner. The studio flash-head can be seen mounted up against the wall. The other studio flash-head is mounted in the same spot on the opposite wall.

A patient to be photographed would stand in the spot behind the door, obviously with the door closed, and a black board behind them as a background.

As an example, Dr. Joel Studin stood in for the ‘before’ and ‘after shots. Here the before and after photos will show how poor the lighting looked ‘before’, and how the lighting improved ‘after’ a few changes in settings, set-up and technique.

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Dr. Joel Studin isn’t really as formidable as he might look there with his arms folded. (He is actually one of the nicest guys I’ve met.) The idea with folding his arms like that, was to show how hard the shadows looked on someone’s body when they were photographed.

The ‘after’ photograph shows how the lighting was improved. Even lighting from left to right, and top to bottom, with gentle shadows which won’t hide detail, but still show some form to the subject.

If you look at this photograph again, you might already figure out what most of the improved results revolved around – changing the direction of the flash-head. But we’re jumping ahead of ourselves now. Let’s go step-by-step how we improved the lighting in this small room …

Three problems can already be seen in where the flash is mounted:

- the height of the flash from the floor will cause light fall-off from top to bottom. ie, the light will be top-heavy.

- the short distance from the flash to the subject means that the light fall-off will be even more noticeable. The subject’s head will be over-exposed, and area around the abdomen will have less light falling there.

- the flash isn’t diffused. This will cause glare on foreheads, and hard shadows.

There is an inescapable axiom with regards to lighting :
the larger your light source (in relation to your subject), the softer the light will be.

I had to figure out a way of softening the light. And I had to find a way of diffusing those flash-heads or spreading the light. But, there really was NO room to add umbrellas or any device to soften the light.

I thought of turning the flash-heads around to point backwards, but bouncing light behind us wasn’t an immediately obvious solution, because of the dark green color of the cupboards:

Then I thought of hanging a white sheet from the cupboard doors to reflect the light. Even though it would be effort to do that every time a patient had to be photographed, the results would look better. But in trying to hang up a white sheet, I opened the cupboard doors, and discovered something …

Holy cow! The insides of the cupboards where white! Problem solved!

We’ll turn the lights around, and just open the cupboards every time someone had to be photographed in that room. Simple! And it is no fuss at all. It would take mere seconds to do this. And when they are done with the photography, they will just close the cupboards.

Making this apparently small change, presented several improvements:

- the light sources are now MUCH larger. Instead of the light sources being the small flash-head which instantly gives us harsh shadows … our light sources are now huge flat areas of white. That entire white cupboard is now our light source. Remember, the larger the light source (in relation to the subject), the softer the light will appear.

- the light source is now lower than before. This should be immediately obvious from the photo. Remember geometry and science classes from your school days?
Angle of incidence = angle of reflectance.
Instead of the light source being the flash-heads mounted high above, the light sources are now the areas that the flash is bounced from. And that is lower than the flash.

If you look at the right-hand photo of Dr. Studin, you’ll see how even the light is. It was done with this basic set-up. The colored items on the cupboard are too small and evenly dispersed to affect the white balance in any noticeable way.

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The other changes made were in how the camera was set up:

We changed to a higher shutter speed to avoid ambient light affecting us. Have a look at the photograph to the right.This was taken with a slow shutter speed, and suddenly the ambient light is affecting exposure, and we get a very top-heavy light again. We need to be rid of that. Shooting at 1/200th of a second side-stepped that problem.

We also changed the camera to the lowest ISO, to get the best image quality. Manual exposure mode, of course.

And from that, we figured out exact exposure settings to keep everything consistent.

White Balance was set to Daylight. Most studio strobes are balanced for daylight, and a Daylight WB setting will give accurate colors. We then fine-tuned the white balance in-camera to give even better skin tones.

And that was pretty much it.

The only downside to this set-up is that Dr. Studin will now have to make sure one of his staff members keep the cupboards neatly packed at all times. But I think that is a small sacrifice to pay for greatly improving the lighting set-up in his consulting rooms.

And the beauty of this solution is that it took up NO more space than it did before – there were no additional pieces of equipment to clutter the room, and no additional expenses. All it took was the application of some fundamental concepts in photography and photographic lighting.

 

{ 4 comments… read them below or add one }

1 MrGreenBug April 5, 2010 at 4:22 am

A very nice piece of article you’ve got here, Neil! Simple yet very effective! Simplicity is beauty isn’t it.?

By the way, I follow your blog, and I just would like to take the chance to say that I have learned a lot from your blog/site. I keep reading your entries even though I’ve read most of them before. I just can’t stop coming back and read them again.

I am hoping to apply all the things I learned here on my upcoming gig.

Thank you for sharing your knowledge.

Reply

2 Dr.Shankarappa October 31, 2012 at 1:27 am

I am a plastic surgeon and i own a Nikon D700 very recently with 85mm,105mm macro and 24-70mm lenses, SB 900 flash and a popup flash diffuser.Kindly tell me the camera settings,flash settings and techniques during plastic surgery operations.Also tell me whether ring flash is necessary..

thank you :)
Dr.Shankarappa

Reply

3 Neil vN October 31, 2012 at 2:13 am

That extensive a topic is perhaps best discussed during a Skype tutoring session

Neil vN

Reply

4 Shig Tokuda October 31, 2012 at 12:24 pm

Neil

This is a really good article as to controlling lighting in a real and tough photo situation in order to get the desired result. Your articles always remind me that photography is about sculpting with various qualities of lights and that reading light(s)and putting them together is as important as choosing photo gears.

Thank you for sharing this problem solving you encountered.

Shig

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