Fact or Fiction: How to Tell if Those Before and After Photos are Too Good To Be True

It is no secret that social media is becoming increasingly important in selecting an aesthetic provider. What better way to get a sense of a potential provider’s work than by viewing his or her before and after photos? Are his or her results a match for what you are hoping to achieve?

What is lesser known, however, is that the ubiquity of social media does not come without its risks. Perhaps most alarming is that there is no effective regulation of what is posted. The viewer, understandably, assumes what they are seeing is the “real deal.” Unfortunately, if you are seeing results that are too good to be true, they probably are. And Photoshop often isn’t even needed to create these exaggerated or outright fake before and after photos. Here are just a few tricks to watch out for. There are many more out there, but these should give you enough of an idea of what’s possible so you can be on the lookout and be a more informed consumer.

Let’s start with neck and jawline contouring. Improved jawline contour and neck aesthetics are achieved by getting rid of excess fat and skin from the jawline down to and including the neck and / or enhancing the mandibular border. These results can be achieved surgically (necklift) or non-surgically (threads, fillers, radiofrequency, etc.). Similar results can be achieved for a photo without doing anything to the patient at all. Before and after photos are taken from the side view. In the before photo, subtly flexing the neck will give the appearance of increased skin excess, laxity, and wrinkles. In the after photo, the neck is subtly extended to reverse these changes. A profound difference can be shown with only slight changes in neck flexion that the casual observer would likely not notice.

How about wrinkle reduction? The severity of wrinkles is determined in large part by the way in which light hits those wrinkles. If light is directed from the side, wrinkles tend to be more visible because they cast small shadows. If the light is directed from the front, no shadow is cast, and the wrinkles are barely visible. Therefore, many wrinkle reduction treatments ranging from facelifts to Botox and fillers can be misleadingly photographed by shifting the position of the lighting in the before and after photos.

We’ve talked about how to fake it for the face. What about the body? The appearance of the results of body contouring procedures can be dramatically enhanced through body and clothing positioning. For example, extending the elbow can enhance the appearance of results of arm liposuction. If the before photo is taken with the elbow flexed, and the after with the elbow extended, the back of the arm will be stretched making the result more impressive. The arm beyond the elbow can even be cropped out of the photo making it difficult to detect the position change. In terms of clothing, it is easier than it may seem to cover imperfections in results with careful clothing placement.

So, before and after photos are a wonderful resource, but they should be taken with a grain of salt. Here are some basic tips to make sure you are looking at legitimate pictures. First, and this may sound crazy: is it the same person? Look for tattoos, moles, bone structure and other things that are hard to change. Then look at lighting. Are the shadows roughly the same in both pictures? How about the angle from which the picture is taken? A subtle change here can have a dramatic impact on the perceived result. What about body position? Is the subject holding the same pose in the before and after photos? Finally, look at clothing. If it is different in the before and after shot, this may be fine as it is sometimes beyond the photographer’s control. Just make sure it is positioned similarly in the before and after photos so your view of the work being showcased is not significantly influenced.

I hope this guide was helpful! Feel free to join the conversation and reach out with questions or comments in our Facebook group at www.facebook.com/groups/askaps.

Office of Darren M. Smith, MD

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