Patient Tutorial: View Before and After Photos Through the “Eyes” of a Plastic Surgeon

In our Patient Tutorial Series, we want to help you, the patient, better determine fact from fiction on cosmetic surgery websites. We’re not saying that all cosmetic surgery websites provide inaccurate or misleading information, but in a field like cosmetic surgery that boasts revenue over $10 billion a year, it’s an area that attracts all types of “get rich quick” schemes. White coat deception, or doctors claiming to be trained plastic surgeons, is a serious problem for patients being duped into receiving treatments from less-than-savory establishments. In an effort to protect yourself from this deception, our first tutorial below teaches you how to critically review before and after photos, the way a real plastic surgeon would.


Obviously every physician wants to show you their best results in the photo gallery section of their website. On some level, there’s a subliminal suggestion that all of their patient’s results look equally great, but that is not possible. Whether it’s different anatomy or a different body shape, and less frequently due to a true complication, not all patients will have the same great result as those seen on a website. That being said, if their “best” results on their website aren’t that great, it suggests that their more common results may be mediocre as well.  So here are some pearls of wisdom.


First, look at the quality of the photo. Is it blurry or taken from far away, such that you can’t see details? Is the lighting the same in both the before and after photo? Often times, if the after photo has less shadow and is overexposed, it will hide the wrinkles seen in the before photos. See the photo below for a prime example.


before and after photos
These photos submitted by a physician, were posted on Regardless of what you think of the overall results, the flash is much brighter in the after photos and therefore conceals any remaining wrinkles the patient has postop. Thus making the results harder to compare.


In the photos above, the flash is much more intense in the after photos and since the ‘before’ photos have shadowing, you can really see the wrinkles before surgery. But with the overexposed ‘after’ photo, it’s hard to know what happened to those wrinkles – was it the surgery or the flash photography that “erased” them?!  Compare this to results below from my website that were taken by the amazing photographers, Pat Shoda and Janine Sot at the Cleveland Clinic. You’ll notice the same lighting and same positioning of the head.


before and after photos
Same lighting in both the pre and postop photos.


It’s easy to compare the results of the surgery above since all other variables – differences in lighting, exposure, position, resolution – have been removed from the equation.


Lastly, be sure the position of the body is the same in the before and after photos. There are 5 standard positions in before and after photos: 1) frontal, 2) left side, 3) right side, 4) right oblique and 5) left oblique. The same patient from my website above, will demonstrate these angles below.


befoe and after photos
The five basic plastic surgery photos for a patient undergoing surgery. Great photography by Pat Shoda and Janine Sot at the Cleveland Clinic.


In summary, if the photos are not of the same quality, same position or similar lighting, you have to question what the doctor is hiding because they assume you won’t notice – but now you will after reading this tutorial!


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