How to scrutinize Before and After Photos

Patients love to see “before and after” photos. I agree – it’s one good way to see the quality and artistic vision of a plastic surgeon.

Unfortunately, photographs can be manipulated to look better or worse. And I’m not talking Photoshop here. Simple tricks of timing, positioning, and lighting can be used by the unscrupulous.

So – here’s a quick guide to analyzing surgical photos, to make sure they are honest.

1. There should be plenty of photos. If a surgeon has no good photos to show you of your procedure – that’s a big red flag.

2. Photos should be taken with the exact same body position, both before and after. For example, watch out for face and neck lift photos where the “before” photo is taken with the patient looking down (making the before neck look worse), and the “after” photo is taken with the patient looking up (making the after neck look better).

Facial photos should be taken with a calm expression on the patient’s face – no raising of eyebrows, smiling, or trying to pose. Breast lift photos should be taken with the arms in the same positions both before and after – no lifting of the arms in just the post-op shot!

3. Photos should be taken with the same camera, using the same technique. No black and white “before” photos compared to color “after” photos, please. Before and after photos should be the same size, too.

4. Make-up and hair should be consistent in both photos. For facelift photos, the hair should be pulled back, so you can fully see the ear area, and relevant incisions around it. If someone is showing you facelift photos and every single one has the bangs hiding the ear – they are intentionally hiding the surgical scars. Go somewhere else!!

5. Timing of photos: As we all know, initially the area that has had surgery is swollen. If a photo is taken during this time, certain features will be artificially emphasized. For example, breasts will look fuller and rounder, faces will look smoother, forehead lifts will look less wrinkled than what they will look like once the swelling has resolved. Therefore, it’s important to know when the photos were taken. We take our post-op photos no sooner than 3 months post-op for this very reason. It’s more honest.

6. The lighting should be consistent. For example, “before” photos of facial scars should not be lit tangentially (from the side) to exaggerate the scars with harsh lighting, while the post-treatment photos are taken with soft frontal lighting, to make the face seem smoother. This kind of trick is sometimes seen on laser resurfacing sites.

If you know these basic guidelines, it’s amazing just how many sub-standard photos you will be able to spot on various websites. If somebody tries to “con” you with a bunch of these kinds of questionable photos – then go somewhere else.

It’s really all about honesty – this time in photography.

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Fiala Aesthetics | Plastic Surgery & Med Spa