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    Misleading Before and After Photos

    I read quite a few medical journals. I also read medical magazines, which are not peer- reviewed (pass strict evaluation by board of doctors). The magazines are advertiser supported; free to qualifying specialists. Since advertisers pay, you quickly get the implication. They are paying to get their message across to the readers.

    Such publications may take liberties that the tightly-scrutinized medical journals dare not take.

    The magazine that I was reading claims to have a circulation of “30,000.” That’s huge. I do not know whether all recipients are physicians. I suspect that it is sent to not only physicians in the specialties of dermatology, facial plastic surgery and plastic surgery, but possibly to certain large skin clinics and day spas.

    The emphasis in this particular magazine is high-tech machinery, e.g. laser systems, surgical instrumentation, that is used for skin resurfacing and rejuvenation, liposuction, breast augmentation, and acne treatment. I need not tell you that this is a big industry talking to doctors via this magazine. These mega-companies need to sell a lot of equipment.

    I happened to be leafing through the most recent issue and noticed an article written by the publication’s contributing editor. It highlighted a particular type of laser resurfacing system, which ostensibly improves wrinkles and fine lines as well as erasing some pigmentation.

    The article included a commentary from a dermatologist who supported this particular technology. Be advised that these articles are somewhat advertorial; they are subtle advertisements cloaked in the appearance of editorial content. I recognize that and always factor that it into my digestion and analysis of the article.

    The most important criteria to judge the quality of the article and the benefit of the technology or technique being presented, are the before and after photos. These are the currency of the value of the purported cosmetic change.

    This article particularly offended me. As my eye went back and forth between the “before treatment” photograph and the “after treatment” photograph, I immediately noticed two things. First, in the after photo, the patient appears to be wearing some makeup. But even worse, the lighting is different. In the after photo, it is very easy to see that the lighting is directly in front, e.g. the flash or light source is directly in front of the subject, as it should be. Yet in the before photo, the lighting must be coming from above; you can discern that from the shadowing pattern. Further, the tell-tale sign that the lighting is from above in the before photo is the “flash bounce” on the upper forehead. That could only be produced by a flash or light source situated above the face and hence likely to cast the shadows I mentioned above.

    I suspect that most readers of this magazine, who dwell in the world of cosmetic surgery and allied specialties, are reasonably sophisticated and should detect what I call “gaming” the results.  But what about those who are not so sophisticated?  What about the younger doctors?  What about those who have not had good enough training in their residencies to be able to distinguish between the proper, objective and technologically consistent “before” and “after” photos, and those that are not?

    It takes a trained eye — and the practitioners of the cosmetic specialties need that — not only to best care for patients, but to be able to best evaluate new technologies, processes, and procedures.

    In my residency at the University of Illinois, we had our own medical photography department.  We were trained by experts.  We were taught how to do it right and thus recognize improper and unprofessional medical photography.

    It does not compliment our profession that a physician would submit such photographs to a medical magazine. Obviously, such mischief demeans the publication.  I do not know whether the doctor is on the payroll of the company whose product is being hyped in the article, but what I see and read does not pass my smell test. Such photographic misbehavior immediately dismisses from consideration any possible use of this particular technology. To me, the company shot itself in the foot by participating in a bit of chicanery.

    I share this with you because today, more than ever, you need to be a sharp consumer.  I addressed the subject of medial photography in my encyclopedic book, Secrets Of A Beverly Hills Cosmetic Surgeon,The Expert’s Guide To Safe, Successful Surgery so that prospective patients, viewing “before” and “after” photos will know how to separate honest, objective “befores” and “afters” from the other kind. I want my readers to be able to view and digest reputable results and be sophisticated enough to be able to dismiss misleading photos.

    ~ Robert Kotler, MD, FACS


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