Photos are over-rated

While the popular advice is to look at photos, I think pre- and post-op photos by themselves give very limited information especially if shown cold on a website or by surgical consultants who have not done the actual surgery. While patients look for similar patients for the results that they can get, anatomical nuances are not evident in the photos. For example, a protuberant abdomen can be caused by subcutaneous fat or weak muscles or intra-abdominal contents. Breast appearance and subsequent augmentation can be affected by rib contour. Nasal profiles can be quite varied intra-nasally that will might affect how surgery is performed or what breathing problem might have resulted.

In addition, the pre- and post-op results are not only influenced by what you begin with, but also by what the goals are. The goals can be determined by the patient, by the surgeon, or as a collaborative effort. One patient might have one result and another a different result and the end results might be judged as the surgeon's inconsistencies or judgment while in fact it might be due to patient choice.

The best way to judge a surgeon is to talk to him or her about his or her philosophy and to talk to patients about whether or not they are happy with the result. The actual result is less important than if the individual patient is satisfied with the surgeon's efforts.

Before-after pictures should  be taken with the same camera and lighting and have the same background.  The photographs should show how long after the procedure they were taken.  They should be taken from the same standardized angles.

Some before-after results are literally taken in the surgery room, obviously not an indication of how the patient will look at 6 months to one year.  Pictures taken shortly after surgery will have swelling that often makes the results look better.  Photos taken with different lighting can also make the after picture look better (or worse).  Bodybuilders who slim down before competitions will appear to have obtained near miraculous ab sculpting results.  Buttock "lift" patients will appear to have obtained fantatstic results... at least at the first week after surgery.  Well lit after pictures show miraculous facelift rejuvenation results.  Computer photoshopped pictures can show amazing results and you might never know they had been altered.

Esteemed publications now are very picky about medical photography.  Many of the pictures you see in advertisements and on many websites would not pass muster because they are misleading or lack the elements above. 

When you see the before and after views looking as though they had been taken at different angles, when the duration of time between the photos is not given, or under different lighting, those pictures should be suspect.

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