Fake or Real Plastic Surgery Photos?

What are tips to make sure the plastic surgery pictures, before-afters, I see are real. I have worries that fakes and retouching will hide the truth!

Doctor Answers 10

Good Photos are very important - Surgeon with Excellent Training + Great photos is ideal

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By good photos I don't just mean "wow" before and afters but good quality, consistent placement and consistent lighting.
When a staff member discovered our images posted on another site without our agreement we were mortified. Yes, this can happen. When viewing photos in the office notice whether or not all the photos are taken with the same background, same lighting and with the same (at least 3) positions. Ask for information including patient's age, and how long after surgery photo was taken. Most importantly, ask, did you perform this surgery? Did you perform this as the primarly plastic surgeon? Has this photo been retouched?
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.
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.
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.
Photos are a very important of the decision making process, but not the single most important factor in selecting a plastic surgeon. Check their bacjground with your state medical board, their membership with the ASPS and speak to many of their previous patients. You may also want to check with your primary care physician, or other medical professionals you know.

Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 123 reviews

Good question - photos are very important but need to be viewed wisely

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This is an excellent question!

The best situation in my opinion occurs when a prospective patient sits down with a plastic surgeon and runs through many photos (un-retouched or digitally altered!) of that surgeon's own patients. I personally spend an hour with each new patient and do not relegate this to any body else. The subtleties of each photograph can only be explained in person and are often missed on web sites.

Also, about 75% of patients don't really know what they look like and so finding comparable patients to themselves on web sites is obviously impossible!

The photos are an excellent way of examining what the skills of the surgeon are and what they think looks good. You should see in that doctor's results something that you would like for yourself if you are going to have surgery by them.

It takes a careful eye to spot the fakes.

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This is a great question. Most plastic surgeons and other people practicing cosmetic surgery make websites and post photos. I have found that many websites do not even post their own photos. In fact, if you look carefully, you can see the same photos on multiple websites. That is because many people subcontract out their website creation to companies that use stock photos. This is most consistent on the landing page of the websites. In the before and after sections, you should look for consistent backgrounds and photographic techniques. Additionally, people often stretch the photos to make the patient look thinner after surgery. Look for asymmetries between the before and after photos in areas that should not be different - such as the width between the eyes, the distance between the teeth or lips and the eyes, the distance between the ears, the distance between the hip bone and the shoulders, etc. Also, look at markings on the patient such as location of moles or tattoos to see how these are altered between the before and after pictures.

I hope this is helpful.

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Photos should be honest and reflect long term results

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Before-after pictures should be taken with the same camera and lighting and have the same background. The photographs should show how long after the procedure they were taken. They should be taken from the same standardized angles.

Some before-after results are literally taken in the surgery room, obviously not an indication of how the patient will look at 6 months to one year. Pictures taken shortly after surgery will have swelling that often makes the results look better. Photos taken with different lighting can also make the after picture look better (or worse). Bodybuilders who slim down before competitions will appear to have obtained near miraculous ab sculpting results. Buttock "lift" patients will appear to have obtained fantatstic results... at least at the first week after surgery. Well lit after pictures show miraculous facelift rejuvenation results. Computer photoshopped pictures can show amazing results and you might never know they had been altered.

Esteemed publications now are very picky about medical photography. Many of the pictures you see in advertisements and on many websites would not pass muster because they are misleading or lack the elements above.

When you see the before and after views looking as though they had been taken at different angles, when the duration of time between the photos is not given, or under different lighting, those pictures should be suspect.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 194 reviews

Website photos alone are not enough

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This is a great question, and unfortunately there is no easy answer. Just looking at website photos alone are not enough, and I think it is very helpful for a patient to sit down with the surgeon and go over the pictures directly, so the surgeon can describe to you specifically what he sees and how he aimed to improve it-- this will also allow you to decide if you and the surgeon have a similar aesthetic ideal.

Another option is to speak to his patients directly-- they will give you their honest impression as to if they were happy with the results and also if the results were long-lasting.

In the end, you have to decide if you trust the surgeon to get you the result you desire, and I think meeting him or her face to face will go a long way in helping you make this decision.

Dr. S

Shahram Salemy, MD, FACS
Seattle Plastic Surgeon
4.9 out of 5 stars 155 reviews

Photos are over-rated

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While the popular advice is to look at photos, I think pre- and post-op photos by themselves give very limited information especially if shown cold on a website or by surgical consultants who have not done the actual surgery. While patients look for similar patients for the results that they can get, anatomical nuances are not evident in the photos. For example, a protuberant abdomen can be caused by subcutaneous fat or weak muscles or intra-abdominal contents. Breast appearance and subsequent augmentation can be affected by rib contour. Nasal profiles can be quite varied intra-nasally that will might affect how surgery is performed or what breathing problem might have resulted.

In addition, the pre- and post-op results are not only influenced by what you begin with, but also by what the goals are. The goals can be determined by the patient, by the surgeon, or as a collaborative effort. One patient might have one result and another a different result and the end results might be judged as the surgeon's inconsistencies or judgment while in fact it might be due to patient choice.

The best way to judge a surgeon is to talk to him or her about his or her philosophy and to talk to patients about whether or not they are happy with the result. The actual result is less important than if the individual patient is satisfied with the surgeon's efforts.

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon

Ask to speak or meet with Real Patients

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Hello Liza,

I agree that closely looking at the photos will help you determine which ones are real clinical patients and which are stock photos.

Also ask your Doctor for referrals - you should always be able to speak with or meet prior patients who have worked with the Doctor to get their experiences and comments on the procedure you are considering.

Most patients who are willing to have their photos used are also willing to talk and meet with new, prospective patients. A real patient who has gone through a procedure with the Doctor you are considering is an invaluable resource - much more so then before and after photos!

Kamran Jafri, MD
New York Facial Plastic Surgeon

Plastic Surgery Photos

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In theory, no Surgeon should show a result of another surgeon without full disclosure and certainly should never alter photographic images for the purposes of deceiving a patient.  However, there are Surgeons who do not follow the rules and some skepticism is appropriate. I would recommend that any patient ask, "Are these untouched photos of your work?"  I recommend that a patient consider the postoperative photos as one piece of the puzzle in choosing a Surgeon.  Other issues for consideration include the Surgeon's local reputation, your gut feeling about the Surgeon, his/her office, his/her staff, and the way you are treated.  Cosmetic Surgery is not for everyone and a patient should never feel pushed to have anything done. When viewing photography, look at consistency in lighting, standardization in head position, and ask questions about things that catch your eye. In my opinion, patients who have see or met my past patients have the best idea about the work I do and are generally the most convinced about the work I do.

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon
4.9 out of 5 stars 104 reviews

Photo integrity

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There is no absolutely perfect method to evaluate photos.  I think the best quality photos are those that are high resolution and shot with the same camera, angle, and lighting before and after surgery.  What is probably the best advice is to find a surgeon you can trust.  Then, you can be assured of their integrity throughout the whole process.  A personal referral or recommendation is far more reliable than advertising.

Good luck!

Jason Hess, MD
San Diego Plastic Surgeon

FaKe or real pictures

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First of all, I would go to a board certified plastic surgeon.  Second, always ask if these are pictures of his/her patients.  Third if the physician has an imaging system, the most common is called Mirror, when a picture has been altered there is an icon in the lower right corner.  Look at multiple results. 

If your physician does not generate a sense of confidence and trust at the time of the consultation as well as educate you with regard to the procedure you are considering, this is not the right physician for you.

Roger J. Friedman, MD
Bethesda Plastic Surgeon

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.