Why is that some plastic surgeons have few before/after pictures on their website? Does this mean that the doctor is not credible or popular enough?
Plastic Surgeons' Websites - No Photos?
Doctor Answers (6)
Plastic Surgery Before and After Photos
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.
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.
Choosing a surgeon
Since my training years the view on this has turned 180 degrees. When I was training patients were not shown photos of before and afters because of the implied guarantees. One of my professors would only show prospective patients text book photos. With the onset of the internet, increased direct to patient marketing vs. old fashion word of mouth referrals and increased competition between doctors for new patients viewing before and after photos became the norm. Then you could not show during surgery photos in fear of scaring off patients who saw blood. With the introduction of plastic surgery reality shows and documentary television shows showing actually surgery that also changed. Now it is OK to show most prospective patients during surgery photos. With internet improvements this is all done as movie clips now.
This created a backlash as some patients felt this was an invasion of privacy. Now in California we have a state law that states you have to have signed permission from the patient before the surgeon can use photos or movie clips of the patients in anyway where they may be viewed by anyone not directly involved in the patient's care related to that surgery. I have posted a number of photos and movie clips but could have done much more if I had patient permission. The number of photos or movie clips posted online alone should not be the main factor in choosing a surgeon.
My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.
Website Photos and the Quality of the Surgeon
It makes good marketing sense for a Surgeon to display as much of his/her work as possible. The trend toward the use of visual media has increased and will only continue to increase in the years to come. However, in my training, there were very good Surgeons who did not believe in showing postoperative results. The decision to include and how much to include in presentation to prospective patients varies from practice to practice based on available willing patients, the motivation of the individual Surgeon to update a website, and the length of time in practice (younger surgeons will typically have fewer results they can show). Although a prospective patient's decision must include some tangible objective proof of a Surgeon's work, it should also include a comfort level with the demeanor of the Surgeon and the office staff, the "word of mouth" rating in the community, and a general gut feel about the practice.
Website and photos
Each surgeon is a bit different, and some patients allow you to post photos while others do not. I just put up a sample of some general procedures that I do with approval of the respective patients. I do not think it correlates in any way to the quality of the surgeon.
Photos on Websites
There is no established correlation between photos on websites and the skill of the surgeon. Many surgeons use photoshopped pictures or even pictures of patients that are not even their own. Also, many surgeons put pictures of their patients on the web without specific consent from the patients. While seeing pictures is a good reference or starting point for a consultation with a surgeon, a better way of judging a surgeon's skill is to discuss results / patient experience with the surgeon's previous patients. Also, many patients agree/consent to having their pictures shown in the office, but prefer not to have them shown on the web. Finally, most high profile patients choose not to have their pictures shown on the web or in the office to protect their privacy.
Websites without photos
I have been in practice 23 years in Beveerly Hills and over those years have learned that while showing photos are the norm, it is very, very difficult to judge a surgeon by photos. Also, while websites are the modern day business card, you wouldn't go to a place of business simply because of how their business card looks. The web levels the playing field but having a terrific-loking website doesn't mean you are a terrific surgeon.
A patient cannot usually judge how a pre- or post-op photos might or might not relate to her specific situation. Photos do not tell you if the patients are happy or unhappy. Photos don't tell you if the results were a product of the surgeon's goals, the patient's desires, or a compromise of both.
The best way to judge a surgeon is by reputation, usually with other doctors, especially gynecologist who see eveery women who has surgeon, and by speaking with patients, not necesarily because of their actual results but because of their experience with the surgeon. Whether they are happy or not is often more important than what they actually look like.
Robin T.W. Yuan, M.D.