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

Question

Imagine how easy it would be to do that. more pics, more "credibility".........:/ plus I have seen the SAME nose job before and after photos on DIFFERENT surgeon websites (and I research stuff thoroughly). So now I am paranoid because I have breathing difficulties. Is there any way to separate fact from fiction?

Ronald J. Edelson, MD · Answer

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.

Scott C. Sattler, MD, FACS · Answer

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

Gerald Minniti, MD, FACS · Answer

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!

Toby Mayer, MD · Answer

Photoshopping before/after photos? We have had our photos show up on websites in several different countries as well as in the USA. Meet with the surgeon's patients. Busy experienced rhinoplasty surgeons have patients in there office daily who will meet you.

Steve Laverson, MD, FACS · Answer

Excellent question.  Photoshopping gallery pix or posting other surgeons' results that are not accurate or representative of the site owner's work is misleading, unethical, and demonstrates the surgeons' untruthfulness to his or her own prospects and patients.  In my opinion, trust and integrity are foundations of the doctor-patient relationship.

Robert Kotler, MD, FACS · Answer

Dear roseicon12 in Beverly Hills, California:

It is a good question.  If you see the same nose jobs on before and after on different surgeon’s websites maybe there is a little bit of “copying and pasting.”  The truth is that the most experienced, sophisticated, and specialized surgeons do not need to Photoshop.  Their results are good.  You are going to learn about the integrity of an office when you visit it.  Generally, the higher caliber offices give you a good feeling that would engender trust and confidence.  That is why there is no substitution for consultation.  You must visit and office and meet the doctor and the staff to really get a good sense of what the practice is all about.

You want to do your homework before consultation.  Prepare well for your consultation.  When you search, look for rhinoplasty super-specialists.  These are surgeons whose practice is the majority or entirely devoted to rhinoplasty, septoplasty, and related procedures.  This would include both primary and revision rhinoplasty surgery.  Why not have the most specialized talent in your service?  Consider how much experience the surgeon has doing the procedure you are considering. We all get better at what we do with time and so those surgeons who have a long run of experience are the ones who have learned the most from experience. Residency and fellowship are where the learning begins, but for all of us, time and experience is where the education continues.

Part of your preparation for consultation should be preparing a list of questions beforehand.  Bring a notepad or ipad or laptop with you and take notes as the surgeon answers the question you are asking.  You should spend more time with the surgeon than with the office administrative staff, because you need to get a sense of whether you are comfortable with the doctor.  You should not feel rushed that you are on a consultation conveyer belt.  If the presentation by the office staff seems a bit to “salesie” that is a bit of a yellow or red light.  Take a friend or relative along since two heads are better than one in gaining information and understanding.  In the end, the purpose of the consultation is for you to be educated and be comfortable, not to be “sold”.  Ask yourself two key questions: “Is this surgeon teaching me or selling?” And secondly, “Can I put my life and my face into this particular surgeon’s hands? Can I trust him/her?”

There are excellent books out there that you can read and use to study up. It is worth the homework time you put in up front so that you make the right decision with respect to choosing a surgeon who has the talent, experience, and degree of super-specialization that you certainly want to have.

When you visit doctor’s websites, the most important feature on the site is the before and after gallery.  If there are just a few examples of rhinoplasty or revision rhinoplasty, you wonder how much experience the surgeon has performing such surgeries.  There need to be dozens and dozens of examples.  The more examples there are, the more likely you will see one or more that demonstrate situations similar to yours.  Look closely at the photos for natural results.  That is what you want.  Nobody wants to carry a sign saying “I have had a rhinoplasty.”

Reviews on review sites, particularly RealSelf are very important and should be carefully digested. The larger the number of reviews the most accurate the picture of the practice and particularly the doctor. A consensus is generally correct.

A consultation without computer imaging is, in my opinion, of much less value.  Why shouldn’t you see the predicted result of the procedure the doctor is proposing?  At consultation, photos are taken of you and loaded into a computer system that morphs your present appearance into the anticipated “after” based on the nasal surgeons input.  Imaging is an incomparable learning tool because it provides a forum for doctor and patient agreement on what would satisfy the patient and what is, in the doctor’s opinion, achievable.  After all, cosmetic surgery is 100% visual.  It is about appearance, so without a visual evidence of what is planned, how can you make a decision as to whether or not you might be satisfied.  Talking about it is worthless.  To anticipate a successful outcome, there must be a meeting of the minds between surgeon and patient.

Best wishes,

Robert Kotler, MD, FACS

Over 4,500 nasal procedures performed

Edward Farrior, MD · Answer

rosiecon12,

Although the surgeons that perform rhinoplasty are performing elective surgery they are bound by the same ethics that bind all physicians. Honesty, integrity and a commitment to do no harm. That being said I have witnessed the use of photographs to deceive. This is easier than photoshop, it can be done with head position, lighting, shadows and makeup. The imaging programs provided to plastic surgeons for photo achieving place a water-spot on all altered photos. This is not the case with Adobe Photoshop so photos can be altered with little evidence. Choose an ethical physician based on references not a web site and you will be fine.

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