If a picture is worth a thousand words, then a set of before and after pictures counts for even more – especially for potential patients searching online for a plastic surgeon. Standard advice in selecting a plastic surgeon always includes reviewing their before and after picture sets (in addition to verifying board certification, facility accreditation, and so forth.) But how much do pictures really tell about the surgeon? The following is my advice on how to evaluate and use before and after pictures.
First, keep in mind that specific patient consent is required in order to post pictures online, or even to show them in an album in the doctor’s office. They are part of the medical record. It can be a challenge to get patients in for long-term follow up, take photos, and obtain consent to post them. Because I respect my patients’ privacy, I feel like it is a big ask. This is especially true for facial procedures where the patient’s identity cannot be concealed. For these reasons, a large number of photos does not necessarily imply that the surgeon is busier or better, only that they have a more active marketing campaign. If you are concerned about privacy, you may even want to find the surgeon with the fewest pictures on their website!
Second, look for standardization of photographic technique. The before & after pictures should be taken with the same background, lighting, and pose. The now-defunct Life Style lift was a classic example of how altering things such as the position of the flash can cast things in a more favorable light, so to speak. In their “before” pictures the light source may be off to the side, accentuating every wrinkle like sand dunes at sunset; in the “after,” it is straight on, reducing any shadows. And of course having the patient pull their chin down in the before and up in the after doesn’t hurt either. Unfortunately, these kinds of tricks make it difficult to assess how much of what you see was from the surgery.
Ultimately, all you can really get from before and after pictures is a sense of what the surgeon believes his or her typical good results are. If what you see seems off, but the surgeon thought these were good enough to post, then that is not the surgeon for you. If on the other hand you are impressed, then that is a good starting point for discussion of what your specific goals and expectations are. Just don’t use pictures to decide on the details of your procedure; a designer dress might look just as good on you as on a runway model, but that doesn’t mean it will look the same, or that it’s the best dress for you.