How to evaluate Before and Afters

Helpful hints for evaluating Before and Afters

By Dr. Killeen, published on June 10, 2021

helpful tips for evaluating before and afters

I have patients showing me collections of before and afters every single day.  I spend a lot of time discussing why certain photos are a “good” before and after, or a “bad” one. There are lots of misleading images out there on social media, but here are a few tips for evaluating before and afters like a pro.

1. Lighting

The lighting should be the same in both photos. Harsh, overhead lighting shows every single dent and divot.  Bright, forward-facing lighting masks it. If someone is showing you a before and after of cellulite or liposuction irregularities that have bright lighting in the seemingly perfect after, they are misleading you.

2. Perspective

The patient should be the same “size” in both photos. This is a classic move done to hide results from liquid rhinoplasties and body contouring liposuction. With liquid rhinoplasties, the nose is ALWAYS larger. They are adding volume! If the nose is smaller, they are trying to mislead you.

With body photos, the shoulder width in general should be the same on both photos. If the person looks like their shoulders shrunk in the second photo, they are trying to mislead you. The hips can be a good reference point as well, but if this area was liposuctioned, this is not as reliable.

3. Time

Early post op results often look great (on the OR table, one week, or one month). The scar is typically nearly invisible and the results look just like they did on the operating room table. Swelling is still somewhat present and will nearly eliminate the appearance of wrinkles and stretch marks.

The reality is that things change significantly over the coming year. Every single scar will become more pink and thick after the one month follow-up and then gradually fade. Breasts settle and scar tissue can pull and tether. Wrinkles and stretch marks return as the swelling disappears.

If the patient still has bruising, it’s an early B&A. The most impressive results are long term (6 months and on). One of the most common type of B&A’s that are misleading are those of liposuction revision. These are complicated cases that ALWAYS look smooth right after surgery. As the tissue heals and swelling resolves, the dents and divots reappear. Often much better, but never completely gone.

Other common offenders are BBL’s and “high def” lipo. The smooth round buns and sculpted abs of these patients right after surgery never look the same 6 months or more out. If your surgeon is only showing you immediate post-operative photos, you should be asking yourself why? Although you are probably starting to understand now!

4. Angle

Patients should be in the exact same angle for the before and after photos. Changing the angle slightly can really change the result. For a facelift or facial skin tightening if the patient is looking down in the pre-op, and up in the post-op, this is misleading because it stretches the neck and makes the skin look less loose in the post-op.

5. Arms up or down

This one is common with abdominal tightening procedures. If your arms are up, your abdomen looks smooth and tight, but down, not so much. Arms up or down don’t matter, but it should be the same in both the before and after.

6. Facial expression

The patient should have the same facial expression for both photos, if they are smiling in one and not the other, the face is distorted and it’s difficult to really see what the surgery or procedure actually did.

7. Photoshop

We all know there are people doing it, don’t fall victim. You see this more with non-invasive procedures like MLM skin care, rather than surgery, but I’ve seen it in surgery too. If it seems too good to be true, it almost always is. I will say though, it is completely acceptable to photoshop out identifying moles, tattoos, or jewelry. Usually the tell tale sign of a fake B&A is smooth textureless skin, and areas of the face appearing smaller following filler injections. Those cover the majority of photoshop fails I see.

8. The patient had way more done than listed

This is only something I really see with skin care B&A’s, mostly from MLM companies. I’ve even had friends who saw an actual facelift patient of theirs photos being used by an MLM skincare company stating the result was from skincare. Please just avoid MLM skincare, they are all average at best. There are tons of fantastic companies out there that do not exploit women in a toxic pyramid scheme!

9. Weight loss

We all wish plastic surgery would lead to weight loss, but it does not. Liposuction is a contouring procedure. If the patient is smaller all over (look at arms, neck, legs, ankles), it’s likely weight loss is contributing to the after you see.

The above are not always a sign that the Doctor is trying to mislead.  Sometimes photos are just taken incorrectly, but it’s important to always be looking for these subtle things before you sign on for a procedure based off of a kick ass B&A.