Cosmetic Surgery: Promises and Pitfalls™

Before and After Pictures: Seeing is Believing... or is It?

Publicly displayed before and after pictures (ads, marketing seminars or internet) may help you make the decision to have cosmetic surgery but they may not be the best way to select a surgeon.

WHERE IS THE BEFORE AND AFTER PICTURE GALLERY?

We have resisted the marketing pressure to feature a gallery of before and after pictures on our website. We are very proud of our results, but have had strong ethical reservations featuring such a gallery. The following considerations have influenced our opinions and hence our website:

• Patient Confidentiality: It seems unethical or, at minimum, insensitive to a female patient to publish her nude pictures on the internet for the world to see. Most of our patients who have facial surgery want their surgery to be confidential. (Would you want your pictures on the internet?)
• Patient Selection: Any savvy consumer must assume that only the best results are exhibited in a marketing website.
• Picture Selection: Certainly the most favorable views are the ones exhibited.
• Photos Are Two Dimensional: What looks good may feel firm and abnormal.
• Each patient is unique: What is shown in before and after pictures represents the results in that particular patient and has little bearing on any future patients' results.
• Marketing is the primary value of before and after pictures exhibited on a surgeon's website. While our website has marketing impact, we have attempted to provide ethical and factual information for potential cosmetic surgery patients.
   

OUR APPROACH

• We believe that THE DISPLAY AND DISCUSSION OF BEFORE AND AFTER PHOTOS IN THE CONTEXT OF A PERSONAL CONSULTATION BY THE SURGEON CAN BE VERY IMPORTANT IN THE PATIENT’S UNDERSTANDING OF THE PROPOSED PROCEDURE.
• In our consultations, our surgeons (not an assistant) show and discuss before and after pictures in our patient conferences. While we are happy to show the quality of our results to prospective patients, the intent of showing photos is to illustrate specific points related to the procedure.
• We make an effort to show A SPECTRUM OF OUR RESULTS - good, average, and those that illustrate potential problems or complications.
• Photos are used to help ensure that our patients have REALISTIC EXPECTATIONS in regard to surgical results.
   

PICTURES - REPRESENTATIVE SAMPLES?

One can only assume that photos used in an advertising context are very carefully selected. How does a consumer know whether the results portrayed are a true representation of that surgeon’s work or his/her career best?
 

PHOTOGRAPHIC TRICKS?

Glamour Shot?

This is from an actual article: Texas Monthly/November 1981

You will notice that in advertising by cosmetic surgeons, (see Promises and Pitfalls: How to Analyze an Advertisement - Consumer Beware!) many physicians will use the same photo over and over for years. It is only natural that surgeons present their work in the best possible light, but this can lead to unintentional (or intentional) misrepresentation. Photographic techniques such as lighting, poses, hairstyles, makeup, clothing and jewelry can significantly enhance one’s appearance.

THIS IS OBVIOUS IN THE BEFORE AND AFTER PHOTOS SHOWN BELOW IN WHICH THE PHOTOGRAPHER, NOT THE SURGEON, IMPROVED THE SUBJECT!

An interesting example of this is seen in photos of these two models. No surgery was performed before the second photo was taken. Pretty spectacular results! (Photographs used with permission from Hilton Becker, M.D., Boca Raton, FL.)
As another example, even a movie star's appearance varies with the photographic conditions. (Photos published in the National Enquirer.)

 
COMPUTER IMAGING

Digital enhancement is prevalent in modern photography, allowing top quality images, as well as a wide range of special effects. However, the potential for misuse of this technology is the problem; it is impossible for the consumer to be sure of the authenticity of post-operative photos.

In cosmetic surgery, computer imaging may be used as a basis for discussion of potential results. (See Promises and Pitfalls: Computer Imaging.)

 
PHOTOS ARE TWO-DIMENSIONAL

In certain procedures, the appearance of a body part reflects only one aspect of the result. For example, a hand, which appears normal in a still photo, yet actually has a severe functional impairment, only seems to represent a good surgical result.

Though the breasts appear very normal, the right breast is very hard.

Similarly, a breast, which appears attractive, but is very hard, is not what it seems! Thus even comparable before and after pictures tell only part of the story!

In the marketing of cosmetic surgery, the use of photographs serves as an enticement. The implication of wonderful before and after poses is that surgery is a simple solution for an individual’s concern. Further, success and happiness are stressed, while complications, cost, convalescence, etc. are minimized or disregarded.
 

More of our information on how to choose a doctor and how doctors advertise is on these pages:

• The Three Most Important Questions to Ask When Considering Cosmetic Surgery
• Promises and Pitfalls: "Best Doctors" Lists - What They Really Represent
• Promises and Pitfalls: Free Cosmetic Surgery Consultations
• Promises and Pitfalls: How to Analyze an Advertisement: Consumer Beware!
• Promises and Pitfalls: The Marketing of Cosmetic Surgery: Beauty for Sale
• Promises and Pitfalls: Testimonials: "Thank you, Doctor Wonderful!"

 
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