Background: Patients increasingly use photographs taken with a front-facing smartphone camera - "selfies" - to discuss their goals with a plastic surgeon. The purpose of this study was to quantify changes in size and perception of facial features when taking a selfie compared to the gold standard of clinical photography. Methods: Thirty volunteers took three series of photographs. A 12-inch and 18-inch series were taken with a front-facing smartphone camera, and the 5-foot clinical photography series was taken with a digital single-lens reflex camera. Afterward, subjects filled out the FACE-Q inventory, once when viewing their 12-inch selfies and once when viewing their clinical photographs. Measurements were taken of the nose, lip, chin, and facial width. Results: Nasal length was, on average, 6.4 percent longer in 12-inch selfies compared to clinical photography, and 4.3 percent longer in 18-inch selfies compared to clinical photography. The alar base width did not change significantly in either set of selfies compared to clinical photography. The alar base to facial width ratio represents the size of the nose in relation to the face. This ratio decreased 10.8 percent when comparing 12-inch selfies to clinical photography (p < 0.0001) and decreased 7.8 percent when comparing 18-inch selfies to clinical photography (p < 0.0001). Conclusions: This study quantifies the change in facial feature size/perception seen in previous camera-to-subject distance studies. With the increasing popularity of front-facing smartphone photographs, these data allow for a more precise conversation between the surgeon and the patient. In addition, the authors' findings provide data for manufacturers to improve the societal impact of smartphone cameras. CLINICAL QUESTION/LEVEL OF EVIDENCE: Diagnostic, III.
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