Facelift Surgery Before and After Photos

This is really an excellent question and one that every person seeking plastic surgery should understand.  There are two aspects to this answer.  The first is the evaluation of the photography technique. Many seemingly improvements are the result of subtle photographic techniques. Second is an evaluation of the surgical result. 

Technique

1. lighting- watch to make sure that the same amount and direction of  the light is the same in the before and after.  If the photo is underexposed (darker) then wrinkles look worse and conversely if the photo is overexposed (lighter) then wrinkles and scars tend to disappear. It the flash is off to the side in the before photo it will make the wrinkles look worse and if the lighting is "straight on" in the after photo it will make the wrinkles/scars look better. The appearance of the color should also be the same.  (This is the color saturation and white balance which is easy to manipulate with digital photography.) 

2. focal length- watch to make sure the distance from the camera is the same in both photos.  While this may not be as important in evaluating facial surgery it is very important in body surgery.  A common "trick" is to make the before photo closer and the after photo further away making the patient look thinner. 

3. position of the head- this is very important in facial surgery.  If the preop photo has the head tilted down and the post operative photo has the head tilted up the result will look better just by photography alone.  When plastic surgeons take photos we strive to have the head in same "neutral"  position.  (it is called the Frankfurt line) in the before and after photos. 

4.timing of the photo- the photos should be at least six months after the surgery so that by that time any swelling (which will hide fine lines) has gone.

5. make up-  Is the before photo devoid of make up and the post operative photo with full make up. Make up can make a very dramatic result by itself. 

Surgical result

1. does the result look natural?  Is there improvement in the appearance of the neck, cheek, jowls. Is there any evidence of distortion. Look carefully at the corners of the mouth.

2. appearance and placement of the scars.   Are the scars fine and well hidden?

3. appearance of the hair line. Has the hair line been distorted?

4. look carefully at the ear position and appearance of the ear lobes to make sure they are not distorted.

With all of these points in mind don't worry to much about "what is good" - you will know. Remember beauty is in the eye of the beholder.

Best to consult with a board certified plastic surgeon to ask their opinion with regards to post op expectations.  Best of luck.

A good result from a facelift is a patient who looks natural, and not like they have had a facelift.

When evaluating facelifts, look closely at the ears and the hairline. Look for scars in front of and behind the ears, and visible scars in the hairline. My goal is that even a hairstylist cannot detect scars. Just as importantly, look at the contour of the ear and the shape of the hairline and / or sideburns. "Pixie ears" and altered hairlines are not only dead -giveaways of facial surgery, but they make people look odd and unattractive. 

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.

If a patient is wearing no makeup and a frown in the before image, and is fully made up and smiling in the after image, this is not a good representation of a surgical outcome.

The following are a few things that can distinguish some surgeons from others

1) Graduating from a top tier medical school at the top of their class.

2) Membership in Alpha Omega Alpha. This is the medical honors society. Alpha Omega Alpha is to medicine what Phi Beta Kappa is to letters

3) Formal surgical training from prestigious medical universities. The minimum number of years of surgical training for plastic surgeons to be board certified in five years. Some physicians have as many as ten years of formal surgical training. There simply is no substitute for stelar academic and practical surgical training.

4) Very experienced surgeons with meticulous surgical technique and natural looking outcomes will have photographic evidence of their work. Patients should be able to view many photos of the surgery of interest, photographed from three different perspectives all with similar lighting, distance from the camera and cropping

The elite experience extends beyond the surgeon to the facility, and the surgical team. You should be able to see the surgical theater and know who else will be in the OR with you during surgery. The Joint Commission (JCAHO) is an organization that provides certification to hospital OR's. The Joint Commission and AAAASF are two of the organizations that can provide certification to surgical suites. Some plastic surgeons elect to have their surgery centers dually certified.

The anesthesia experience is critical to a safe and comfortable surgical experience. A board certified anesthesiologist can administer general or MAC anesthesia. My preference is to have a board-certified anesthesiologist at the bedside of my patients for the duration of surgery.

Plastic surgeons who cater to high profile individuals who place a high value on privacy will have a private first floor entrance and exit so patients never need to be in a public lobby or elevator for pre-operative or post operative visits.


Look for Consistency in photographs

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.


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.

You want to look for several things:

-find a patient that has similar anatomy as you...pay attention to the jowls and the hanging neck skin and find an example that looks like you

-a good facelift looks natural, not that wind swept look, make sure you like the results

-there should be a difference in the before and afters that is noticeable and what you want

-the jowl area can be the hardest part to control, so see if the jowling is corrected as well

I agree with you, it is important to see your plastic surgeon's before and after face lift photos before deciding to undergo a face lift with that surgeon.  Here are a few things to look for in before and after face lift pictures:

1.  Look at the before and after face lift surgery results.  Do the patients have a decrease in forehead wrinkles, a tighter neck line, less jowling, less marionette lines, and a refreshed look?  Are these results that would make you happy?

2.  Look at scars in the hairline, in the upper eyelid crease, lower eyelid crease, in front of the ear, and behind the ear.  Do these face lift scars seem acceptable to you?

3.  Look at the new hairline and side burns.  Do you notice differences before and after facelift surgery?  Is this acceptable to you?

4.  Look at the ear lobe.  Does the ear lobe look natural or stuck to the side of the neck?  There should be a normal break between the lower portion of the ear lobe and the upper neck.

5.  How long postoperatively were the pictures taken?  Does the surgeon show any long term results (5-10 years) of patients?

6.  Consider the number of before and after face lift photos the plastic surgeon is showing you.  Are there only one or two photos that represent the very best results, or a wide array of patients, types of surgeries, and results?

7.  Consider the quality and lighting of the photogragphs.  Are there shadows and a lack of makeup making the preoperative phots look worse?  Are the before and after photos standardized for each patient?

This is a great question because so many people do not know what to look for.  in general. you should look for before and after facelift photos that look good to you.  In other words, does the surgeon achieve results that look good to you.  Many surgeons will say look for natural results and you will see all sorts of advice here and else where, but it is your opinion that matters most.  

I hope that helps.

Best regards.

This is a great question, and not one that many patients know to ask. Essentially, there are two aspects of a facelift result: the surgeon’s technical skills or objective abilities, and his/her personal aesthetic. For the former, this includes clear indications of poor quality, like scarring, a “windswept” look, odd lumps, etc. The latter, on the other hand, simply applies to your subjective opinion of whether you like the results the surgeon achieved. Everyone has their own aesthetic vision, so it’s important that yours aligns with your surgeon’s. Remember that in the operating room, your surgeon will be the one making judgment calls, so you should be able to trust his/her cosmetic taste.

While you’re reviewing each surgeon’s before and after photos, whether online on in the office, you should also keep an eye out for uniformity among each set of photos. For instance, was the “after” photo taken in more flattering lighting or from a different angle? Is the patient wearing a more youthful hairstyle in the “after” photo? Look at the details (jowls, cheekbones, etc.) to make sure it’s actually the surgery that makes the patient look younger – not their makeup or facial expression.

For the most part, people are looking for a nice neck contour, smoothing of the jowls, and a decrease in the marionette lines.  Check for a result in those areas which are to your liking.  Incision placement without alteration of the hairline is also important.