Can Some Doctors Get Away with Putting Fake Before and After Pictures Up?

I am considering rhinoplasty but saw a couple reviews of people that had it done saying it went terrible and the doctor that did it put a fake picture of them up! That freaks me out as I search for the right surgeon for me. I think the before and after pictures are really important and that's one of the key things I look for in a surgeon. HELP I'm freaking out now.

Doctor Answers 10

Before and After Photos

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Sadly, some surgeons have used fake before and after photos, or at least photos that are not their work. In fact, my office manager discovered  several of my own before and after photos (and some of my own written material) taken from my website and posted on several different cosmetic surgery sites without my consent.  A word of caution to physicians: Write your own copy. I found my own copy on the websites of several surgeons who were "sold" the my copy for use on their site.  They had no idea content on their site was written by me for my site. My office manager used a website that looks for duplicate copy. We now regularly run reports with this service in our practice.

  I think asking a doctor the questions 1) is this your patient? 2) Did you perform the surgery yourself? 3) Did you photograph this patient yourself could help.  Also look to see if the before and afters have similar lighting and background, or if they seem to be a mish mash of images. 

Here are some other tips for evaluating before and after photographs. 

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.

Other Considerations

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.

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

How to Spot Forged Photos

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There are 2 types of photos that mis-represent reality.  The first type may or may not be by accident and can generally be determined by examining the photo.  The second type is pre-meditated deception and not necessarily something that you can figure out looking only at the photos.

1) Poor photographic technique is a very common way to have photos mis-represent reality.  Generally this involves using very different techniques when taking the before and after and may not be pre-meditated.

- Differences in make-up are very common and to some extent expected.  Significant differences should make you consider the photo comparison useless.  Major differences in make-up may or may not be a pre-meditated action, but should at the very least be considered sloppy on the part of the physician and reflect poorly on him if he has chosen to show the photo.

- Lighting is a very common error.  I see this constantly, even in medical journals.  The before and after MUST be taken with the same lighting.  Look at the eyes, you should see a reflection of the light source (flash).  It should be nearly identical in the before and after.  If the eye is not in the photo, look at the shadows and any "flares" reflecting off the skin, they should be nearly identical.  If the photo is so cropped down that you can not see eyes or other structures that throw shadows, consider the photo useless.  Wrinkles, scars, and cellulite will look totally different with different lighting.

- Patient position is another issue.  The slightest change in position can alter things such as loose skin, wrinkles, and cellulite.  Be wary of any photo that is so cropped down that you can't tell if the position is identical in before and after.


2) The above items may be pre-meditated, but often are just the result of being sloppy.  They reflect poorly on the physician but don't amount to fraud unless done on purpose (at least in my opinion).  There are other tricks that can only be pre-meditated.  This involves using "morphing" software.  It will be difficult to spot this type of modification just looking at the photo since it was done on purpose and if the person has any skill with the their photo program, virtually impossible to tell.  Only the overall reputation of the physician can help you to spot this.  The only acceptable manipulation of a photo is to crop it and make minor adjustments in such things as brightness, contrast, and color balance in order to have the before and after photos become photographically balanced.  Doing this properly improves the accuracy of the before and after comparison.

Louis W. Apostolakis, MD
Austin Facial Plastic Surgeon
4.8 out of 5 stars 37 reviews

Fake Before and After Rhinoplasty Photos?

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Hi Rayah,

It is sad but true.  It's one thing if a nose looks fake after an actual rhinoplasty (to be avoided at all costs!), it's quite another to misrepresent false photos as actual results.

There was a New York rhinoplasty physician who was actually arrested and jailed because he had photo-shopped his before and after rhinoplasty photos.  Most physicians who do show before and afters choose their best results. 

It is best if at the time of your consultation that you ask if any staff members have had their surgery from your prospective surgeon, and/or if you can meet any other patients who have had the procedure.  It sounds like you are making the effort to choose your rhinoplasty surgeon most carefully, which is very important.  Good luck and be well.

Dr. P

Michael A. Persky, MD
Encino Facial Plastic Surgeon
4.8 out of 5 stars 39 reviews

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Fake Before and After Pictures in Rhinoplasty

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Although this practice is uncommon, there are no guarantees about the ethical behavior or lack thereof in your Surgeon.  Both the AAFPRS (American Academy of Facial Plastic and reconstructive Surgery) and ASAPS have guidelines about advertising and use of photography which should deter the majority of false representations, but are by no means foolproof. Seeing a range of surgeons before proceeding with surgery allows the prospective patient to compare and contrast the culture of the office, the demeanor of the surgeon, the quality of the results, and the overall feel of the practice.  Before and after pictures are very important, but should represent one facet of your decision making process.  Other factors should be the experience of the surgeon, whether or not he/she makes Rhinoplasty a featured part of the practice, and your own sense of whether you are being educated on the procedure or "sold" on grand expectations.  If you aren't convinced, seek further consultations and take the time to make sure you are comfortable with this important decision.

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

Before and after pictures

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No, they shouldn’t. Ethical surgeons use their own before and after photos.  Look for a very experienced rhinoplasty surgeon who has performed thousands of rhinoplasty procedures and has extensive experience with the type of nose that you are interested in.  Excellent before and after pictures are important, but not the only parameter in choosing a surgeon.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 158 reviews

Can Some Doctors Get Away with Putting Fake Before and After Pictures Up?

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 Sadly, yes.  I heard of one doctor taking photos from magazines as his after shots.  I have attended conferences where multiple doctors and surgeons were complaining about others taking and using their before and afters.  The current internet environment is "buyer beware" unfortunately when it comes to photos, reviews and these sorts of things.  As a consumer the best way to start looking for an MD or plastic and cosmetic surgeon is to choose one that understands and follows the proper aesthetics of facial and body beauty for the creation of a naturally more attractive appearance.  If the aesthetic understanding seems lacking in the surgeon one might question stellar before and after results. 

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 28 reviews

Fake photos?

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I would like to think all my colleagues are honest with their work and photographs.  But, like with anything in life, there is always one bad apple that spoils the hole bunch!  I think that you have to meet the doctor that you are interested in going with and review photos in their office.  I do not post alot of rhino photos on my site, because my patients do not want their faces posted to the world!

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Fake photos

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Unfortunately, unethical behavior can be found anywhere and physicians are not exempt.  The American Society of Plastic Surgery goes to great lengths to  monitor the  behavior of its members.  If you suspect your physician is involved in such activities, you should report them to the American Society of Plastic Surgeons.

You need to do your due diligence when choosing a plastic surgeon. Besides all the required credentials, look at their review, all photos, and try to get word of mouth referrals.  You may also want to ask the PS to refer you to patients he or she already operated on.  

Be critical,

Good Luck,

Ary Krau MD FACS

Ary Krau, MD, FACS
Miami Plastic Surgeon
4.7 out of 5 stars 358 reviews

Pre and Postop Pictures

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      I think most plastic surgeons have accurate representations of before and after pictures.  I would try not to let this be a deterrent to seeking out plastic surgery.  Other things that you may want to take into account is board certification, number of surgeries performed by the surgeon, credentials, etc.

Image Modification/ Alteration

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 This is somewhat of a controversial area in Aesthetic Surgery. What you are referring to I believe is image modification/ alteration in an attempt to show a patient what they might look like after surgery. It is typically done with/ through a computer program purchased by the surgeon. There are many. Some practitioners feel it helps them to get better idea of what a patient is expecting after their surgical procedure. Other surgeons feel that it results in UNREALIST EXPECTATIONS OF SURGICAL OUTCOMES by some patients. Remember that these image modifications/ alterations are not normally considered part of a contract for a expected result in a court of law.
  Some practitioner purchase photographic library’s of before and after patients as part of an advertising campaign from companies selling very expensive products. This is more common with manufactures of lasers, liposuction assistance devises, etc. Often, it is better to view your surgeons actual patient photographic library to get a good idea of their patient outcomes. Do not forget to ask; “Doctor, are these your actual patients?”
  All these issues have been around for decades evolving disclosure and ETHICAL SURGICAL PRACTICE. Members of the ASPS & ASAPS are required to follow specific Ethical Guidelines of practice, advertising, billing, behavior, etc. with serious sanctions/ consequences if they are not followed. This often assists the patient from being deceived. May I suggest you seek one out in your area. It most likely will help you from freaking out. Best,



Gary R Culbertson, MD, FACS

Gary R. Culbertson, MD
Columbia 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.