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Should I Be Concerned if a Plastic Surgeon Has No Photos on His Web Site?

Doctor Answers (8)

Plastic Surgery Before and After Photos

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Look for both QUALITY and QUANTITY of before and after photographs

For many years we have made 'before and after' images available to prospective cosmetic surgery patients exclusively by means of email contact following inquiries to this website, and during in-office surgical consultation. Many satisfied patients have remarked that they found this policy to be very appealing when they were in the process of gathering information and selecting a surgeon. The intent of this policy has primarily been to do our very best to protect the confidentiality of our cosmetic surgery patients, a responsibility which we take very seriously.

Additionally, we have had some misgivings about the easy access of such photographs, some of which are of a very private nature, to anyone with a PC and an internet connection - whether or not they are actually in the process of considering a plastic surgery procedure. We have also had the experience of discovering the unauthorized use of our photographs on other websites, and for this reason we are limiting the number of 'before and after' photographs available at any one time for each surgical procedure. We will be rotating the photos that are displayed on a regular basis, and many more images will be available for prospective patients who are seen in the office in consultation.

There is no denying the fact that 'before and after' images are the most powerful and effective means for a surgeon to communicate their aesthetic sensibility. They give the prospective patient an immediate sense of what that surgeon envisions as a favorable postoperative result, and thus allow an individual to make a relatively quick decision as to whether or not that surgical practice is one that they should investigate further. It also has become challenging for us to manage the number of email inquiries that we receive for information about surgery and example photographs. Now that almost all prospective patients expect fairly easy access to 'before and after' images, we have felt an obligation to add this feature to michaellawmd.com.

Prospective patients have a host of issues to consider when evaluating pre-op and postop images of cosmetic surgery patients. An outspoken plastic surgeon who is known for some keen observations is often quoted as saying that "A photograph is merely reflected light". Another telling maxim regarding cosmetic surgery photography is "Almost anything can be made to look good from at least one angle." Both of these observations speak to the fact that while such photographs should ideally communicate the true nature of a surgical outcome, there are inherent limitations to the two-dimensional nature of photography.

Look for Consistency

For this reason, as a consumer you should insist on consistency in preoperative/postoperative photography. The positioning of the subject and the size or 'aspect ratio' in the photographs should remain consistent. If one photograph appears to be taken from five feet away and the other from eight feet away, there is no way to meaningfully interpret the 'transformation'. The lighting and color saturation in all of the images should also ideally be identical, or at least comparable. If the pre-op image is in shadow and the postop image is well-illuminated, there is no way to determine how much of the postoperative 'improvement' was provided by surgical technique and how much is just better lighting. A bright flash can conceal a whole host of flaws.

You should also insist on seeing images from multiple angles, as this is the only way to get some idea of the quality of a surgical result in three dimensions when reviewing two-dimensional photographs, and to confirm that it isn't just from one direction that the result looks acceptable. The photography set-up and photographic background should be consistent. Images taken in the pre-op area in front of a bare wall with an exposed electrical outlet and the patient's gown pulled up but hanging down into the image should not inspire much confidence. Body position and facial position should also be consistent. I have seen breast lift (mastopexy) before and after photographs in which the patient's arms were at her sides in the 'before' images, and then the arms were lifted above the head in the 'after' images. Raising the arms overhead produces an instant 'breast lift', so it is impossible to objectively assess the effect of surgery in photographs where body position is inconsistent.

Likewise, if the pre-op image of a facial rejuvenation surgery patient shows a sleepy-looking person in a hospital gown at 6:30 a.m. on the morning of surgery, and the postop image shows that person in full make-up at 2:00 p.m. on the day of a follow-up appointment several months later, you have absolutely no way of accurately determining what in the 'after' photo is due to surgery and what is due to a good night's rest and some make-up. You may not be aware that all board-certified plastic surgeons receive training in photography as they are trained as surgeons, so that they have a means to accurately document and communicate their surgical planning and the results of their handiwork. I personally believe that a surgeons's photographic technique and documentation provides a person who is considering surgery a very clear statement of how organized, meticulous, compulsive and attentive to detail that surgeon is. If I were a prospective patient I would not expect any of those qualities in the operating room if I did not see them in the 'before and after' photographs. I believe that consistency and quality in photography is a reflection of consistency and quality in one's approach to patient care.

All 'before and after' images from this practice that are provided online, via e-mail and during consultation in the office are photographs of cosmetic plastic surgery patients treated by Dr. Law who have consented to the use of the images. Absolutely no photo re-touching or digital enhancement is used to 'improve' the images or to alter in any way the appearance of the surgical result.

Other Considerations

When evaluating photographs, also keep in mind the fact that many examples you see of a particular procedure may not look like you. Part of what makes the practice of plastic surgery so interesting and rewarding for me is the fact that no two patients are exactly alike, and thus each patient requires a fresh and personalized approach. Rather than trying to dissect how a particular result relates to you personally, view it in terms of that patient's particular 'starting point', and whether or not the surgical enhancement is aesthetically pleasing and natural-appearing.

Don't limit your investigation to an examination of photographs. Review the content of a cosmetic surgeon's website thoroughly, and get a feeling for that doctor's individual approach and practice philosophy. Get a feel for whether the website is attempting to provide useful information or is just trying to sell you something. Determine if the priority is communicating the surgeon's aesthetic sensibility, or getting you approved for easy financing.

Also, another important source of information about a surgeon and a surgery practice can come from individuals who have experience as patient of that practice. At Michael Law MD, PA / Aesthetic Plastic Surgery we have many cosmetic surgery patients who are willing to speak to prospective patients about their surgical experience and their results. If you are favorably impressed when you meet the doctor in consultation, ask to speak to someone who has undergone a similar procedure, and if at all possible someone who has a similar 'starting point' or similar preoperative concerns.

 

Web reference: http://michaellawmd.com

Raleigh-Durham Plastic Surgeon
4.5 out of 5 stars 31 reviews

Photos on Websites

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Photos are a great way to see the general results of a surgeon's work.  However, you need to keep in mind that all bodies are not the same and the results that you are going to get may not necessarily be the same as another patient.  Many patients also do not want their photos posted on a website.  For instance, are you agreeable to naked photos of you being put on your doctor's website for everyone to see?  Probably not.  However, some patients agree and those are the available photos that surgeons have to display.  There are generally many more photos for you to see in the office since many patients agree to have their pictures shown in the office but not on the web.  Finally, a word of caution that some websites show stock image photos as before and after or even have the same photos that are found on other doctors websites.  Many of these photos are photoshopped on the computer which makes it really difficult to evaluate the authenticity of the results.  

 

Good luck.

Web reference: http://www.ShaferPlasticSurgery.com

New York Plastic Surgeon
5.0 out of 5 stars 52 reviews

Plastic surgery photos on the internet

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Yes. Photos do give you an idea about a surgeon's capabilities and volume but they are only a small part of the decision making process. Many surgeons have photo books in their office or may be just getting up to speed on the internet. Potential patients love to see photos but current patients are reluctant to give consent for use on the internet creating a catch 22 situation for surgeons.

Web reference: http://www.bodysculptor.com/

Chicago Plastic Surgeon
5.0 out of 5 stars 39 reviews

Should I Be Concerned if a Plastic Surgeon Has No Photos on His Web Site

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Regarding: "Should I Be Concerned if a Plastic Surgeon Has No Photos on His Web Site?"

Plastic surgeons are taught from their first days in training to photograph everything. Medical photography is meant primarily to document how a certain procedure, in a certain patient resulted in a certain result. It serves an important educational tool - educating the surgeon on how to fine tune his/her technique and it educates the patients, many of whom naturally forget what they looked like before surgery.

Somewhere along the line, due to economics and the web, photography became a marketing tool. All Plastic surgeons are told to put their patients pictures on their websites because the Before and After page is the first and possibly the only page a visitor would go to. Many visitors go to the pictures before even reading about and getting to know the surgeon!

While the economic benefits of putting Before and After pictures on the Internet are obvious, there are ethical and physical constraints. Those of us in who operate on high profile patients know that while many of them insist on seeing Before and After pictures in their initial consultation, they are extremely reluctant and frequently refuse to allow THEIR After pictures to be shown to my other patients, much less to the entire world on the Internet.  As a result, some of the most discrete high profile practices have minimalistic websites and do NOT display photographs despite having an international clientele. In addition, many non-celebrity patients, especially in very conservative towns where many people know one another, have to gather a lot of courage to come into a Plastic surgeon's office. The last thing they want is their "work" displayed to potential society friends or rivals.

I think a well qualified Plastic surgeon SHOULD be able to show you Before and After photos of his work in this office. I would NOT hold not having photographs on the website against him. You may be dealing with a more principled individual who is bucking the economic benefits of doing so in favor of maintaining his patients' privacy.

Dr. Peter Aldea 

Memphis Plastic Surgeon
5.0 out of 5 stars 52 reviews

Before and after photos

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That depends. Do you mean no photos at all or just no photos of the procedure you wish to have? I would say it is more important what the surgeon says when you ask him/her this question. Posting the photos may be against their marketing philosophy, most of their patients may be high profile and not want the photos seen by everyone etc. If they have no photos for you to see in the office or on the web or actual patients to speak with that would be a red flag. Even if the surgeon is newly graduated he/she should have some photos from their training years.

Los Angeles Plastic Surgeon

No photos on websites

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This is an interesting subject since all articles advising consumers/patients and even medical societies suggest looking at photos. However, it is my opinion that photos are not very helpful in all situations. You do not know if the patient or the doctor determined the procedure or the goal of surgery. You can't compare a patient who you think is similar to you since there are often subtle or not so subtle differences that a lay person can not assess. Photos may be selected in or out depending on the results do you don't see bad results. You don't even know if the photos are the doctor's own patients. And finally, the photos don't tell you if the patient is happy with the experience or the results. Pick a reputable surgeon and ask to speak to former patients if you need confirmation about his practice. I choose not to have photos on my website and even warn patients about drawing conclusions about photos when I show them in my office and I have a extensive experience in plastic surgery. i always prefer they speak to former patients with similar situations.

Beverly Hills Plastic Surgeon
5.0 out of 5 stars 6 reviews

Photos on website

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This is a tough call, because I have a hard time getting my patients to allow me to show their photos. They all want to see photos when they come in, but after surgery many of those same patients do not give me permission to post them on my website, even though they say I can show them to individual patients in the office.

Manhattan Plastic Surgeon
4.5 out of 5 stars 14 reviews

No photos on the web site?

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I would be concerned myself as I would imagine they are very inexperienced and don't have many patients yet.

Seattle Plastic Surgeon
5.0 out of 5 stars 44 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.

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