How do we know plastic surgeons don't Photoshop before and after pics on their website?

Having a high level of skepticism is a necessary part of choosing a plastic surgeon.  I have no doubt that you have some surgeons showing photo shopped pictures.  It's up to you to determine who you feel you can trust and who is the best surgeon for you.

PhotoShop and AlterImage are two software systems that can be used for photo modification. Rhinoplasty photos are particularly amendable to 'editing' with software. 

Hello,Good question.  Unfortunately, there have been allegations of that made regarding doctors in my town by ex-employees. I'm sure it occurs, but I still have confidence in my colleagues (ABPS certified/ASAPS member surgeons only) that this is fairly rare.  To be clear, Photoshop is almost always used to crop and adjust exposure and color for presentation. However, that should not involve 'morphing' the image. That is why you should choose a surgeon that not only has great photos, but also has been in the community with a great reputation for a long period of time, preferably longer then a decade.  This will increase the odds that this surgeon is solid and does good work.  You can photoshop a digital picture, but you can't photoshop hundreds of happy patients with good results, the basis of our new patient referrals.  Additionally, it's not uncommon to have previous patients (they love to do this, BTW) speak to prospective patients about their experience and results. I usually give 5 names (by their permission, of course).Best of luck!