Proof Or Deception: Exposing the Truth About Before & After Images in Plastic Surgery

Park Avenue Plastic Surgery Class Episode 1

I am excited to announce that I’ve launched a podcast “Park Avenue Plastic Surgery Class”.  Together with my co-host, Doreen Wu, we will explore controversies and breaking issues in plastic surgery.

I have been deeply involved in technology development in plastic surgery and aesthetic medicine for more than 25 years.  Given all the options, it is overwhelming for plastic surgeons to understand where new technologies fit.  This task is even more difficult for non-plastic surgeons.  I wanted to share my perspective with the public about the increasingly crowded and confusing arena of plastic surgery options.  As always, I strive to provide a realist perspective and debunk some myths.

Before and after images were photographs in the old days, and are now digital images shown on a computer screen, tablet or cell phone.   Taken by the plastic surgeon to help with evaluation during consulting for precise diagnosis, for planning procedures and treatments, and to assess outcomes (final results) when taken months after healing is complete, they are an essential part of plastic surgery.  They are also used for marketing purposes on websites, social media, advertising and elsewhere by physicians, and manufacturers of aesthetic technologies.  Images also give us the chance to see how we look to the outside world –not an inverted image as we view ourselves in mirrors.  They often s how us features that we miss in person or when viewing a mirror.

There are few good ways to quantify aesthetic changes and even these often correlate poorly with clinically significant visual changes.  Images are our best way, albeit an imperfect one, for documenting changes.  Before and after images are used in product development and regulatory approval to validate aesthetic technologies like laser and injectable treatments.  In addition to safety data and any quantitative or biological measurements, an obvious visible improvement in appearance on images is essential to insure the value of a new aesthetic technology.

Can we count on images to tell us the truth?  When taking images months apart, before and say 6 months after surgery or a series of treatments, it is almost impossible to take matching images.  Conditions are typically tightly controlled by taking pictures in the same room, with the same lighting, posing and camera settings but small differences in any of these, tan skin in one image but not the other 6 months later, small difference in clothing, muscle tone, positioning can all make big changes to how the images look completely independent of what changed as a result of the medical treatment or surgery.

Some newer technologies help us by matching images digitally using anatomic landmarks or providing three dimensional imaging.  The digital world also hurts us in some ways, making it very easy to retouch or modify images in ways that are not easy to see with the naked eye.  A lot of times this can be detected in a computer lab by analyzing the digital record but this is not an option when looking at websites or social media online.

Given human nature, selection of which images to show, naturally mitigates towards showing the biggest changes or sifting through dozens or hundreds of before and after images to find the one result that is really striking.  Brighter lighting washes out details like wrinkles and skin blemishes.  Sometimes you can tell by looking at the background which may be lighter in the after image.    Raising the arms reduces visible fat contour and skin redundancy in body sites.  These things can be present in images accidently or can be intentionally staged to unfairly represent the results.  Ideally, arms should be shown in before and after body images to verify similar positioning.

Be skeptical when looking at images for these kinds of deceptive differences.  Also, the person seen in a small image on a computer or cell phone display may not really relate to your body size, shape, age, etc.  You can obtain some very limited guidance about what you think looks better compared to another images to refine your aesthetic viewpoint but such images are really not good for decision making about specific procedures or implants, for example.


Important takeaways:

  • Before and after images are our best tool for assessing results in plastic surgery and aesthetic medicine treatments
  • Online images don’t tell much about what result you might get as an individual
  • If it looks too good to be true, or perfect, it’s probably not real.
  • Look for a change to show on multiple images from different angles –if it is only evident on one image, it may not be real.

More coming soon.  Subscribe to avoid missing any episodes at Apple, Spotify, Stitcher or wherever you listen to podcasts.