Question:
I am considering rhinoplasty but saw a couple reviews of people that had it done saying it went terrible and the doctor that did it put a fake picture of them up! That freaks me out as I search for the right surgeon for me. I think the before and after pictures are really important and that’s one of the key things I look for in a surgeon. HELP I’m freaking out now.

Dr. A’s Answer:
How to Spot Forged Photos:

There are 2 types of photos that mis-represent reality. The first type may or may not be by accident and can generally be determined by examining the photo. The second type is pre-meditated deception and not necessarily something that you can figure out looking only at the photos.

1) Poor photographic technique is a very common way to have photos mis-represent reality. Generally this involves using very different techniques when taking the before and after and may not be pre-meditated.

– Differences in make-up are very common and to some extent expected. Significant differences should make you consider the photo comparison useless. Major differences in make-up may or may not be a pre-meditated action, but should at the very least be considered sloppy on the part of the physician and reflect poorly on him if he has chosen to show the photo.

– Lighting is a very common error. I see this constantly, even in medical journals. The before and after MUST be taken with the same lighting. Look at the eyes, you should see a reflection of the light source (flash). It should be nearly identical in the before and after. If the eye is not in the photo, look at the shadows and any “flares” reflecting off the skin, they should be nearly identical. If the photo is so cropped down that you can not see eyes or other structures that throw shadows, consider the photo useless. Wrinkles, scars, and cellulite will look totally different with different lighting.

– Patient position is another issue. The slightest change in position can alter things such as loose skin, wrinkles, and cellulite. Be wary of any photo that is so cropped down that you can’t tell if the position is identical in before and after.

2) The above items may be pre-meditated, but often are just the result of being sloppy. They reflect poorly on the physician but don’t amount to fraud unless done on purpose (at least in my opinion). There are other tricks that can only be pre-meditated. This involves using “morphing” software. It will be difficult to spot this type of modification just looking at the photo since it was done on purpose and if the person has any skill with the their photo program, virtually impossible to tell. Only the overall reputation of the physician can help you to spot this. The only acceptable manipulation of a photo is to crop it and make minor adjustments in such things as brightness, contrast, and color balance in order to have the before and after photos become photographically balanced. Doing this properly improves the accuracy of the before and after comparison.