Submit your question below about any cosmetic procedure to be considered for posting with an answer from one of our board-certified plastic surgeons.
Note: ASAPS cannot give advice about specific medical problems nor should answers provided by responding surgeons be substituted for a complete medical history, work-up and an in-personal medical/surgical consultation. Sorry we can't answer all questions. We try to select questions that have the widest general interest.
How important are before and after patient photos of the procedure one is considering to have?
I have narrowed my search to two plastic surgeons. One has 20 before and after photos of my procedure. Her patients are all photographed from 3 to 5 different angles. Her results are amazing. The other surgeon also has good results, but not as many photos and demonstrating only one to two angles. The surgeon with the better photos is double the price. Is it important to have photos from so many angles? If a surgeon is a perfectionist with photos, will they be a perfectionist in the operating room? My surgery will be an eye lift.
Before and after pictures are important. They give the patient a good idea of the surgeon's work, ability and outcomes. Unfortunately, many plastic surgeons including myself do not put enough effort into this arena of practice. Some surgeons have a devoted photographer or a photography room. This is obviously a much more professional approach. As you mentioned there is often a cost associated with such a business practice.
You should be able to look at individual patient's pictures and make your own determination on which plastic surgeon would be right for you. Use the results of the pictures as a guide. The actual quality and number of the photographs per patient is less important in my opinion.
Gary R. Culbertson, MD, FACS
There is no denying the fact that "before and after" images are the most powerful and effective means for a surgeon to communicate their aesthetic sensibility. They give the prospective patient an immediate sense of what the surgeon envisions as a favorable postoperative result, and thus allows an individual to make a relatively quick decision as to whether or not that surgical practice is one that they should investigate further.
Prospective patients have a host of issues to consider when evaluating pre-op and post-op images of cosmetic surgery patients. An outspoken plastic surgeon who is known for some keen observations is often quoted as saying that "a photograph is merely reflected light." Another telling maxim regarding cosmetic surgery photography is "almost anything can be made to look good from at least one angle." Both of these observations speak to the fact that while such photographs should ideally communicate the true nature of a surgical outcome, there are inherent limitations to the two-dimensional nature of photography.
For this reason, as a consumer you should insist on consistency in preoperative/postoperative photography. The positioning of the subject and the size or 'aspect ratio' in the photographs should remain consistent. If one photograph appears to be taken from five feet away and the other from eight feet away, there is no way to meaningfully interpret the "transformation." The lighting and color saturation in all of the images should also ideally be identical, or at least comparable. If the pre-op image is in shadow and the post-op image is well-illuminated, there is no way to determine how much of the postoperative "improvement" was provided by surgical technique and how much is just better lighting. A bright flash can conceal a whole host of flaws.
You should also insist on seeing images from multiple angles, as this is the only way to get some idea of the quality of a surgical result in three dimensions when reviewing two-dimensional photographs, and to confirm that it isn't just from one direction that the result looks acceptable. The photography set-up and photographic background should be consistent. Images taken in the pre-op area in front of a bare wall with an exposed electrical outlet and the patient's gown pulled up but hanging down into the image should not inspire much confidence. Body position and facial position should also be consistent. I have seen breast lift (mastopexy) before and after photographs in which the patient's arms were at her sides in the "before" images, and then the arms were lifted above the head in the "after" images. Raising the arms overhead produces an instant "breast lift," so it is impossible to objectively assess the effect of surgery in photographs where body position is inconsistent. Likewise, if the pre-op image of a facial rejuvenation surgery patient shows a sleepy-looking person in a hospital gown at 6:30 am on the morning of surgery, and the post-op image shows that person in full make-up at 2:00 pm on the day of a follow-up appointment several months later, you have absolutely no way of accurately determining what in the "after" photo is due to surgery and what is due to a good night's rest and some make-up. You may not be aware that all board-certified plastic surgeons receive training in photography as they are trained as surgeons, so that they have a means to accurately document and communicate their surgical planning and the results of their handiwork. I personally believe that a surgeon's photographic technique and documentation provides a person who is considering surgery a very clear statement of how organized, meticulous, compulsive and attentive to detail that surgeon is. If I were a prospective patient I would not expect any of those qualities in the operating room if I did not see them in the "before and after" photographs. I believe that consistency and quality in photography is a reflection of consistency and quality in one's approach to patient care. All "before and after" images from this practice that are provided online, via e-mail and during consultation in the office are photographs of cosmetic plastic surgery patients treated by our doctor who have consented to the use of the images. Absolutely no photo re-touching or digital enhancement is used to "improve" the images or to alter in any way the appearance of the surgical result.
When evaluating photographs, also keep in mind the fact that many examples you see of a particular procedure may not look like you. Part of what makes the practice of plastic surgery so interesting and rewarding for me is the fact that no two patients are exactly alike, and thus each patient requires a fresh and personalized approach. Rather than trying to dissect how a particular result relates to you personally, view it in terms of that patient's particular "starting point," and whether or not the surgical enhancement is aesthetically pleasing and natural-appearing.
Don't limit your investigation to an examination of photographs. Review the content of a cosmetic surgeon's website thoroughly, and get a feeling for that doctor's individual approach and practice philosophy. Get a feel for whether the website is attempting to provide useful information or is just trying to sell you something. Determine if the priority is communicating the surgeon's aesthetic sensibility, or getting you approved for easy financing.
Also, another important source of information about a surgeon and a surgery practice can come from individuals who have had experience as a patient of that practice. At our office we have many cosmetic surgery patients who are willing to speak to prospective patients about their surgical experience and their results. If you are favorably impressed when you meet the doctor in consultation, ask to speak to someone who has undergone a similar procedure, and if at all possible someone who has a similar "starting point" or similar preoperative concerns.
My personal view is that while before and after photos are helpful, they should play a limited role in deciding on surgery and surgeon. Every patient has to consent to the use of the photos for marketing to other patients, so there is a balance between respecting the patient's privacy and the expectation that a large number of photos should be displayed. One thing that is useful is if the photos show results that aren't consistent with your expectations, then you know that the surgeon has a different concept of what a good result is. But the question here is, is it worth paying twice as much for surgery just because someone has more photos available?