Plastic surgery patients have a strong desire to view before-and-after photos of procedures. In an independent study that I did several years ago, I discovered that out of the approximately 230 patients who conducted their plastic surgery research on the Internet, the majority did so after viewing television shows, listening to radio announcements, and reading printed stories about plastic surgery; and receiving the names of up to three plastic surgeons from friends.

An overwhelming majority of these patients said they used the Internet to locate more detailed information about the procedures that they were most interested in and indicated that they were at the most serious stage of their decision-making process when they did so. William Jervis, MD, of Walnut Creek, Calif, declares, “Patients that see our Web site are ready to go. They are clear in the expectations and their decision to proceed with the procedure.” Furthermore, more than 80% of these participants indicated that they visited more than 100 Web sites of surgeons from different geographic areas and viewed up to 200 photographs of their procedures of choice.

Viewing before-and-after photographs is an important part of the decision-making process. According to David Evans, PhD, MBA, of La Jolla, Calif, founder of Consumer Guide to Plastic Surgery (, “Over the past 6 months, approximately 1 million visitors have searched this consumer guide to locate more information about plastic surgery procedures. In fact, the before-and-after breast-augmentation photo page in the publication is the 10th most visited page.”

At the same time, more delicacy is involved with before-and-after photos posted on the Internet now than in years past. For example, some surgeons have believed that it was important to receive an electronic agreement from the Web site visitor verifying that he or she was aware that the photos may present possible explicit material as determined by some local and national laws. This agreement may also confirm that the visitor is older than 18.

Reza Sadrian, MD, of La Jolla, Calif, explains, “We found it important to provide before-and-after photos. However, it was equally important for our practice to require an agreement that the visitor is over 18 years of age and aware of current laws governing the viewing of such photos in their local area.”

Consider Individual Variance

However, before-and-after photos may not help a prospective patient set a reasonable outcome expectation if the patient does not consider the many factors involved in determining his or her best shape, size, and fit. Patients often do not consider individual variance when they view before-and-after photos. At times, this may compromise the results of the patient’s consultation.

Nathan Leigh, MD, of Edina, Minn, says, “Before-and-after photos are very valuable to patients for giving a range of possible outcomes from the procedure they are considering. They are ‘damaging’ to the patient when they imply a certain result that may not be appropriate for their body shape and type.” Though Leigh has never received a complaint that his photos were offensive, he recently updated his Web site to take precautions to cover areas that are not pertinent to the procedure being shown.

To Post or Not to Post?

One of a surgeon’s first decisions is whether to place any patient photos—fully clothed or unclothed—on his or her Web site. Then, the patient whose pictures are chosen must decide whether they are comfortable with posting the photos on the Web site. This might be the biggest challenge of all.

Yet, patients may feel more comfortable sharing their photos if they believe they are fully informed. They must understand that the photos are being used for educational purposes. They must see photos of other patients who have agreed to post photos so that they know the photos will be tastefully done.

Next is the hold-harmless agreement, which should indicate that the photos may be used for any legitimate commercial purpose. I recommend that you seek an attorney’s advice when drafting one. This agreement, along with the patient’s chart, should be kept in a readily available location should any legitimate commercial purpose come up in years to come. Finally, it appears that it makes the most sense that photos of some kind are crucial to patient acquisition on the Internet today.


One thing is certain: The full advantage of displaying before-and-after photos on a practice Web site cannot be realized without presenting the clinical information associated with the photo being displayed. Clinical information in a breast augmentation—such as the implant’s size and type; the incision and placement location; and the patient’s height, weight, and age—helps prevent confusion about outcome variances between the patients in the photos.

Patients should consider other factors when viewing before-and-after photos. The treated area’s shape and projection may impact the photo’s appearance. For example, in a breast augmentation, the distance between bodily areas—such as that between the breasts and from the rib cage, the relation of the chest wall, and the circumference of the patient’s body—play a role in the variances among patient outcomes versus the patient photos presented on a Web site.

Furthermore, the lighting used to take the photo has an impact on the patient’s appearance. For example, shadowing and bright lighting may make breasts appear larger than they are, and grainy photos may make breasts appear smaller than they are. Shadows that cast downward may make the body size appear smaller.

Milind K. Ambe, MD, of Newport Beach, Calif, adds, “Photos cannot depict a full description of the procedure. For example, the tone of a mature breast differs from that of a youthful breast. This impacts the procedure and outcome. It is difficult to understand true anatomy in a plastic surgery patient from a photo.”

“No” Naturel

In the end, the “naked” photos displayed on most Web sites today do not communicate the “1,000 words” that typical photos do. After all, we know that plastic surgery may impact a patient’s life in more ways than simply changing the treated area’s appearance. It’s important to note such changes.

One of the latest trends addresses the disadvantage of naked-only photographs. MedNet Technologies has developed a way to come closer to the “1,000 words” that the before-and-after photo should convey. The company advocates posting the patient fully clothed and active to help demonstrate the impact of the procedure on the patient’s life.

See also “Get the Picture” in the September 2005 issue of PSP.

As John Pellman, founder of MedNet Technologies, explains, “Before-and-after photos generally do not capture the patient’s facial expression, which can present the patient’s frame of mind. Since a major reason for patients interested in plastic surgery is to improve self-image, capturing a patient’s facial expression in a ‘before’ photograph identifies the feelings about herself prior to surgery.

“The ‘after’ photo can then show the improved self-image in their smile and expression. In fact, patients wearing clothes feel more comfortable about their new frame of mind,” he continues.

Perhaps fully clothed before-and-after photos can be equally valuable for patients today. “Naked” photos can show the surgical results, but as the saying goes, “The eyes mirror the soul.”

Lesley Ranft is a contributing writer for  Plastic Surgery Products. For additional information, please contact [email protected].