Smiles, Frowns and Photo Overexposure in Before and After Photos

I'm just wondering why the before pictures usually show the patient frowning and the after ones smiling. A simple smile in itself will pull up jowls and reverse gravity only for a while, thus enhancing the appearance. Overexposed film will wash out a lot of mistakes and scars as well. All before and after photos should be taken with a frown or a smile for both and the photo itself should be taken with the same lighting, exposure etc. Of course they would never use photoshop at the pixel level to airbrush now would they?


Doctor Answers 2


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Merry, you are very perceptive and it is good to keep a critical eye. These techniques, and others, are done constantly to con people out of their hard earned dollar. Unfortunately, I sometimes catch these in well respected journals also.

I remember, when John Vorhees, M.D. 's ( Chairman of the Dermatology department at Michigan ) article on Retin A and aging was published in the Archives Of Dermatology back in 1988. I oberved that the study patients smiled in the before picture and did not in the after picture. Of course, that would make Retin A's use look good. Since, Ortho, the maker of Retin A, had helped subsidize the study many who noticed this were critical. My own cynicism was tempered by the fact that Kligman, the developer of Retin A ( and Dove soap) had shown us residents, ten years before, that Retin A helped prevent wrinkles. I had the opportunity to use it on my patients for years before the article came out. My patients who faithfully used Retin A had skin which I thought ,subjectively, looked much better because of this. Thus, I believed Vorhees's findings.

My point is that you should be guarded when you analyze photographs (or data for that matter). But keep an open mind. As the saying goes: the proof is in the pudding. You try the product and then you draw your own conclusions. This is similar to any product. We dermatologists have been disappointed time and time again when medications do not live up to their billing. Skepticism is healthy.

While you might be on the mark regarding some of the photography tricks, legitmate, referreed, journals would not publish photographs which were "doctored" with airbrush or photoshopped.

If anybody cares to E Mail me, I will bring up another technique which can slant a study. I would rather not bring it up in this posting.

Virginia Beach Dermatologist

Cosmetic photographs.

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Although our societies request that photos be standardized, it is often difficult for a variety of reasons to obatin identitical before and after photos for a variety of reasons. Sad, dejected, or patients who lack confidence and then undergo a transforming procedure often are proud and happy to show off their operative results and obviously these good results are the ones we tend to select for display. Happy paitents will smile, apply new makeup (try asking a patient to remove their makeup in the middle of the day for the purposes of a photograph), groom more meticulously, tan, wear more revealing clothes, stand more erect, etc. This can make a dramatic difference in the overall photo.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 reviews

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