If a patient gives permission to have a picture taken for educational reasons, and gives verbal AND written consent to have her picture taken, is it a HIPPA violation to use it in a presentation as long as all it shows is the face: no name, DOB, admission date, etc?

Is it a HIPPA violation if the picture is used during a group text discussing the patient's clinical course, again without any HIPPA type identifying details?

I have seen presentations with patients pictures and I think as long as there was permission it is OK even if it contains the face and the patient is aware.

What do others think?

Unless someone wants to claim that the patient was not capable of making informed consent, or was hoodwinked in some way when he or she signed, then no, there is no HIPAA violation.
(Not HIPPA)

I once had pictures taken as a patient that were to be used for educational purposes. I had to sign a consent stating that I agreed to have my photos used for such purposes. There was a disclaimer under each photo stating that it was used with consent of the patient.