Several factors impact a patient’s decision to choose a plastic surgeon and move forward with surgery, particularly their before and after images. But what you see isn’t always what you get, and some doctors modify their photos so that the results come across as jaw-droppingly unbelievable. Unfortunately, photoshopping surgical (and nonsurgical) results has been going on for years, and the immoral lure of faked images with a bait-and-switch hook proliferates since they are easier than ever to manipulate. “It’s tempting to idealize results with a tiny change here and there, but it is wrong and unethical,” says Campbell, CA plastic surgeon R. Laurence Berkowitz, MD.
No matter where they appear, the purpose of before and after photos are to educate, show a doctor’s skills and create social buzz about a surgical practice, says Chicago plastic surgeon Peter Geldner, MD. Despite all the tricks and hacks that some doctors use to wangle images, knowing what to look for is half the battle. Navigating properly through post-surgery pictures may prevent you from falling victim to deceit and ending up an unhappy patient—or worse yet, with poor results. Consider this the ultimate guide to avoiding the pitfalls of manipulated patient photos.
WHY DOCTORS EDIT IMAGES
Unscrupulous doctors partake in unethical practices like modifying before and after photos to amplify the results. That doesn’t mean board-certified plastic surgeons aren’t adjusting their images, because some do. West Orange, NJ plastic surgeon Mokhtar Asaadi, MD says doctors who alter their photos do it because they don’t produce good enough results. “When a practice alters photos to fake dramatic results, they cheat the system to attract more patients.”
Easy-to-use editing apps make it simple for anyone, not just a dermatologist or plastic surgeon, to tweak a photograph. Unfortunately, while image altering may garner more patients, equating to more revenue, in the end, the patient suffers. Dr. Berkowitz tells of a local dermatologist who struggled to elevate himself as the most qualified “cosmetic” surgeon for face and neck lifts. The dermatologist’s patients who underwent facelifts became patients of Dr. Berkowitz because of inadequate correction. “His photographs were obviously photoshopped and lured these patients in,” he adds.
Filler and nose and neck surgeries tend to be amended most, although any procedure is fair game. Some doctors alter the contours of the face post-procedure; others adjust the skin’s quality and texture to make blemishes, lines, and brown spots less visible. Even scars are minimized or, in some cases, removed altogether. “Disguising scars and contour irregularities give the impression that all is perfect,” Dr. Geldner adds.
HOW FAKE PHOTOS AFFECT PERCEPTION AND RESULTS
With photo editing comes the issue of misrepresenting reality versus a false promise. New York plastic surgeon Brad Gandolfi, MD says image altering adjusts patient expectations to unachievable levels. “Patients show Photoshopped images and request those results, which creates challenges.” And this leads to patients feeling misled. “The same can be said for false reviews. You can only fool patients for a finite amount of time,” Dr. Assadi adds.
Doctors and med-spas who feature work that isn’t theirs, promote models or company-supplied imagery, or steal other surgeons’ photos and pass them off as their own advertise results they cannot replicate. “Aesthetic companies showcase their best results. Using these pictures is misleading and not an honest way to communicate with patients,” says Dr. Assadi. Some states require doctors to disclose if they show anyone other than their patients when promoting a procedure or treatment.
WHAT TO LOOK FOR
Identifying Photoshopped pictures is difficult. “Most patients cannot spot forged results, which are misleading and disingenuous,” Dr. Geldner shares. Be mindful of these red flags when perusing images on social media or a surgeon’s website.
- Harsh or bright lighting. Adjusting the lighting can change how a patient looks and blur away imperfections. Some doctors turn down the lighting to accentuate imperfections or use extra bright lighting to make results appear better.
- Different angles and shadows. Take note of images shot at different angles, which pulls features forward and makes them pronounced. Most people may not notice if a before and after don’t perfectly match up. Still, seeing the face or body at a ¾ angle in one shot and straight on in another can hide a result. Even pointing the chin down or up can make a difference.
- Check for watermarks. No matter where an image is posted, a watermark is the only way for surgeons to protect their photos. “Patients should always ensure the photos they see on social media or online are the same ones they see when visiting their doctor,” Dr. Assadi suggests.
- Makeup and hair makeovers. Most before images show a bare face, which isn’t always the case with after photos. Changes to hair and makeup, including false eyelashes or eyelash extensions, can distract from the results.