Can you trust before and after photos?

Scrolling through plastic surgery before and after photos, you may have marveled at the transformative results and wondered if they're too good to be true. You're not alone. While some images accurately show the outcomes of a procedure, others can leave you thinking there's more to the picture than meets the eye.

ASPS Member Surgeons Michael Hakimi, MD, FACS, and Kimberly Singh, MD, offered their take on whether you can trust before and after photos.

"In this age of technology, there's so much that I assume people can do to manipulate their photos, and it certainly does beg the question of what's real and what isn't," said Singh.

Plastic surgery before and after pictures can be a helpful tool for understanding the potential outcomes of a procedure. Still, it's essential to approach them with a critical eye for several reasons.

Many of the images circulating on social media look too good to be true, especially those in which the before and after pictures appear to be entirely different people.

"It's absurd," said Hakimi. "It's almost insulting to people's intelligence when you look at these photos, and you expect people to think this is a fair before and after. Whether it's the jaw position or the body contouring procedure with very different lighting."

Don't take before and after pictures at face value, instead try to figure out where it originated. Check that it is from a board-certified plastic surgeon who is a member of the ASPS.

"As board-certified plastic surgeons, we're trained, and we're held to a different standard when we present our work," said Hakimi.

Chances are images from ASPS Member Surgeons accurately portray a procedure's outcome. Even so, you should still maintain a healthy dose of skepticism.

Selection bias

Many factors can influence before and after pictures. For example, it's natural for surgeons to highlight their best work, which can lead to selection bias.

"Everyone, of course, puts their best before and after pictures forward," said Singh. "I think, typically speaking, you're not ever going to find a bad before and after. It's important to paint the whole picture when choosing a plastic surgeon. Yes, the before and afters are important, but they're not the whole picture."

Most of the photos that are highlighted are the surgeon's most impressive transformations and are aimed at attracting new clients. These images may not accurately reflect the average patient's experience. They also don't tell you if the surgeon is well-practiced in performing the procedure.

"You want to see the photos on their website or on their Instagram that speak to the quantity of the work they do," said Hakimi. "I still think photos are a crucial factor in picking the surgeon, but it shouldn't be the only reason you pick someone."

Lighting and angles

Photos can be manipulated simply by changing lighting conditions, camera angles or poses.

"Sometimes I look at before and after photos, and 'before' the patient's arms are down, and the flank looks full. But in the 'after,' their arms are up in an excited position, and everybody looks better with their arms up," said Hakimi. 

Such variations can significantly alter the appearance of surgical results without any actual difference in the surgical outcome. Compare the before and after pictures to see if they have the same angle and lighting as well as look to see if the patient is in the same pose to get an accurate idea of the procedure's outcome.

Editing

In some cases, before and after photos may be digitally enhanced or retouched to improve the appearance of surgical results. Although reputable surgeons would not intentionally deceive potential patients, it's essential to be aware of the possibility of photo manipulation.

Patient variation

Individuals heal differently, and the final result of a surgery can be influenced by factors such as age, skin type, health condition and adherence to postoperative care instructions. What works well for one person might not for another, making it difficult to predict outcomes based on someone else's before and after photos.

Lack of standardization

There's no industry-wide standard for taking these photos, leading to inconsistencies in how before and after pictures are presented. Differences in background, clothing and makeup can affect the perceived outcome.

Consult multiple sources

Look at before and after photos from various surgeons to get an accurate understanding of what to expect from a specific procedure before you make your choice.

"Choosing a surgeon who is going to operate on you, that you are going to trust to take care of your body, is such an intimate decision," said Singh. "Just like buying a house or choosing a college, you're going to do lots of research."

Read patient reviews

Alongside photos, reviews can provide insights into the surgeon's reliability and the consistency of their results. Surgeon referrals from a friend or loved one are also a powerful recommendation.

Get a consultation

Nothing beats an in-person consultation to understand a surgeon's personality and whether you'll work well together.

"I think fundamentally having a good chemistry and feeling like your surgeon is trustworthy, I think those core, gut feelings are important," said Singh.

Ask questions

During consultations, ask surgeons about the specifics of the photos, including how long after surgery they were taken and whether they are representative of typical outcomes.

Seek real patients

Talking to past patients can provide a more nuanced understanding of what to expect.

"Word of mouth is one of the best ways to pick a surgeon," said Hakimi. "If you've had friends and family who've had work done by a specific doctor, you can see the results in real life."

Before and after pictures can be a valuable tool in your plastic surgery research, but they should be just one component of your decision-making process. Having realistic expectations and choosing an experienced ASPS Member Surgeon who can discuss your likely outcome based on your unique situation is essential.

To find a qualified plastic surgeon for any cosmetic or reconstructive procedure, consult a member of the American Society of Plastic Surgeons. All ASPS members are board certified by the American Board of Plastic Surgery, have completed an accredited plastic surgery training program, practice in accredited facilities and follow strict standards of safety and ethics. Find an ASPS member in your area.