Reconsidering Surgeon Due to Suspected Retouched Photos?

I finally found a plastic surgeon who I liked. However, I recently noticed some pixelation along the contours of the "before and after" pictures on his website that would suggest digital retouching. Should I still have my surgery done with this doctor? He is a double board-certified facial plastic surgeon, previously ENT, and he does both Chin implant and Rhinoplasty (I need both). I am worried that the patients actually look much worse after their surgeries than what the pictures show.

Doctor Answers 11

Potentially phony photos

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You bring up an interesting point. I used to wonder whether some unscrupulous surgeons "doctor" their photos more than their patients. I now know of at least two surgeons who have used morphed photos as before and after photos, which is completely fraudulent, of course.

Amazingly, in both instances the doctors didn't even use another photo of the patient but simply morphed the pre-op images (same clothes, same position, same hair placement, etc.)! One instance was brought to my attention by a recent patient who was consulting with me for a revision. He proceeded to show me a screenshot of the doctor's website where his own picture was being used. And this was someone seeing me for a revision!

Now, there are potentially "innocent" reasons for the pixelation you describe. The simplest reason would be that whoever put the picture up didn't scale it well and so resizing artifacts may be all that it is. The other is that the doctor didn't shoot the photos in front of a proper background and is trying to photoshop a plain, typically blue, background in to make it look professional. Not really ethical, IMHO, but not as egregious as flat out morphing. Those of us who do a lot of cosmetic surgery usually take pride in shooting high quality photos, too. After all, without good photos it's hard to plan the surgery and even harder to gauge our results (quality control!).

The scary truth is that anyone with good software and bad morals can digitally manipulate the "after" photos into looking better than their patients really are. It's not always practical to speak with or meet with another patient, but it's certainly the most objective.


And to get even more ridiculous, there's a group here in town who has photos linked next to the testimonials, but the photos are all stock photos from! No where is there any disclaimer to that effect, and each testimonial is tagged with one of these stock images. Unbelievable!!!

Jacksonville Facial Plastic Surgeon

Reconsider the surgeon

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As a surgeon who has designed, made, and maintains his own website, I have seen many other plastic surgery websites and have scrutinized countless photos on the web. I have seen few doctors with "altered" photos on their websites. There are likely to be several that I have missed, but I think I have gotten good at detecting this form of "doctoring". Most of the ones that I have seen have been directly altered from the pre-op pictures. These are the most obvious type - i.e. the hair is the same, the expression is identical, etc., just the nose is different. But I assume that you are talking about alterations of a real post-operative photo to enhance the real postoperative appearance.

I have also seen several photos which may look altered, but probably are not. one of the reasons is that as picture quality is reduced to make the image size smaller, there is naturally some pixellation that occurs. This pixellation is far more likely to be noticable by the human eye at the trasition zone between the subject and the background in plastic surgery photos. For example, the bridge of the nose is very likely to have pixellation visible when the image quality is reduced to fit a web-friendly format. I can tell you from experience that this can happen with any photo that is reduced in size and quality to download properly on a web page. Clues to look at are the pictures from other angles.

Also it may be possible for you to request images of that patient that are higher quality from the office manager or surgical coordinator. Seeing patients in person is also very helpful. You can often learn more about a doctor in their waiting room than anywhere else.

I hope this helps.

Behrooz Torkian, MD
Beverly Hills Facial Plastic Surgeon
4.3 out of 5 stars 17 reviews

Move on to another surgeon

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If you suspect that the photos are retouched, then it is probably important to move on to another surgeon that you can completely trust. Ask to talk to a patient or two from the practice about their anticipated result.

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

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Go elsewhere.

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If the photographs are altered, you cannot trust this surgeon.  Integrity is something you absolutely need in a cosmetic surgeon. How else can you be sure that your surgeon will do the very best he can for your face.  Go elsewhere.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

See another surgeon

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If you have any doubts about a surgeon, follow your instincts and find someone else.

The vast majority of surgeons are very ethical and honest doctors. I would like to believe that the surgeon you speak of did not do this. However, if you are suspicious, then it is probably for good reason.

John Diaz, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 34 reviews

Check multiple photos of this patient.

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I share your concern, and I would feel concerned if I thought my surgeon were altering photos.

I'm assuming you're dealing with a board-certified, experienced rhinoplasty surgeon with many favorable photos. And you said you liked him.

My hunch is that the photos are legitimate, since if he's experienced, he would not post an unfavorable result that requires "photo-shop" to make it look acceptable.

You could visit your doctor, and ask to see more views of this particular patient that you saw on his web-site. I think if you see a front view, 2 3/4 views, and 2 profile views, you'll regain confidence. Sometimes the "pixelation" can be due to a different camera, different lighting, or different settings. If this is not satisfying, or possible, go with your gut and find another specialist.

I hope this helps, and best regards.

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon
4.9 out of 5 stars 435 reviews

Retouched photos with out proper notation are unethical

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You need to have confidence in your surgeon that he or she is honest. If photos are retouched to make them look better without making a clear note of this, it would be an ethical violation.

I do not have any way of telling you how to make this determination because digital photos can have a lot of changes as they are copied and pasted and projected on the web. You could always ask to see the original photos but this might be too much hassle. If you are sure this is the case then I would go elsewhere but if you are not sure you might ask and see what the answer is to give you peace of mind.

Best Wishes

Dr. Peterson

Marcus L. Peterson, MD
Saint George Plastic Surgeon

Ask to see real patients.

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 Experienced rhinoplasty surgeons have rhinoplasty patients coming and going all the time. These patients usually don't mind meeting with other patients in the office to show the real result!

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 38 reviews

Ask to meet with real patients

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One option is to have our surgeon give you the names of a few actual patients. You can meet with them in person and view the actual finished result. If the surgeon is experienced enough, they should be able to to find a few of their patients who are willing to meet with you. Patients usually have copies of their actual photos and you could ask them if they would share.

Francisco Canales, MD
Santa Rosa Plastic Surgeon
5.0 out of 5 stars 35 reviews

Standardized Clinical Photography

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I have been a photgrapher for over 35 years and have worked in the developement of most of the plastic surgical digital imaging software and hardware. Pixelation is a function of the resolution of the imaging equipment sensors and how high there resolution is. It is possible that certain curved lines, if enlarged enough, will show the pixels.

It is difficult to comment without seeing the photograph, but you should do your research on the physician, and if you are still worried, have him show you the original photo to be sure. If this is the only problem, just ask to see from him a few more before and afters. If they all look "fake" , then perhaps you should go somewhere else.

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.