Honest Plastic Surgery Photography

Thomas P. Sterry, MD

Before and after photos can be misleading.
Medical photography online seems not to adhere to any set of standards. This is for the most part because doctors are trained in medicine and surgery, not photography. On the other hand, I have noticed a few websites that post pictures that I simply don’t believe are honest. They are not typically altered outright, but there is so much more to the story than photoshop alone. Let me try to explain…
Not so long ago, plastic surgeons used to send patients to professional photographers for photographs to be taken. That way they knew that the lighting was standard and that the quality of the photos would be consistent. Typically, they were black and white images because the shadows are more consistent that way.
With the advent of digital photography and the immediate feedback that it offers, plastic surgeons and dermatologists started taking their own pictures. Unfortunately, that is where the photography standards started to get thrown out the window. Most physicians simply don’t have the training or expensive equipment required to take good pictures. Frankly, I’ve been learning as I go along for the last 12 years. While I think my before and after photo gallery is getting better, but I certainly don’t get the quality pictures that I want every time.
In my office I do the best I can to take the same picture over and over again regardless of who is standing in front of the camera. I have a photo room with no windows and controlled lighting. My wall is painted photographic grey to help keep the colors of the patient skin true. And I try to get patients to assume standard positions so that my angles are always consistent. However, one of the wild cards is sometimes facial expression, so I recently started to ask people to allow me to take both a “mug shot” like picture with their face in repose, and also to smile for the camera in another image.
As I’ve mentioned, I’m continuing to learn more all the time. Maybe that is why it annoys me so much when I see other cosmetic surgeons websites who seem to have no concept of what a “standard” is. Not only are the photos “sloppy”, but they are biased toward a positive result.
Now, to be frank, I clearly don’t show my “worst” results online. So, I suppose I’m a little guilty too. However, I also do not actively attempt to pull the wool over the eyes of anyone. I don’t change my setup or use any other systematic manipulation of the patient or surroundings in order to give my postop pictures an unfair advantage over the before shot. I would never be able to look my colleagues in the eyes again if I did. The unfortunate truth is that these practices do go on in many circles.
Consider some of the TV ads that are broadcast for a variety of products. Almost universally the before photo is of a patient lit from above (which accentuates every wrinkle and line on the skin) with a frown on their face, and the after shows a smiling woman using flash photography (which whites out any wrinkles or lines). It’s unfathomable to me that this ploy is used for so many products and services. What’s worse? They get away with it! That is why advertisers keep using the technique. Unfortunately, I’ve seen a few physician websites that employ the same tactics.
So, in summary, I suppose what I’m saying is that one must be careful and look at all the results online with a jaundiced eye. I’m also promising that my pictures are authentic.

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