News Special: Standardising Before and After Photos

By Ellie Holden / 04 Oct 2022

Aesthetics looks at a new study on social media before and after photos and investigates why the standards of photography are low in the aesthetic specialty

Taking before and after photos is a common part of an aesthetic appointment. As well as being vital for medicolegal and insurance purposes, they also allow the patient to see areas of improvement and the end results of their treatment. Furthermore, with patient consent, the photos can benefit the practitioner as they can be used as a marketing tool on social media to highlight your work to prospective patients, and the results you can achieve.1,2,3 Despite this, a new study has shown that many before and after photos may be of substandard quality, taken with inconsistent photography parameters such as lighting, angles, facial expressions and more.

In the study, a total of 510 social media posts encompassing 2,020 clinical photographs published by 102 practitioner accounts on Instagram were audited for photographic quality. The images were evaluated using a newly proposed Standards for Evaluation of Photographs in Aesthetics (SEPIA) nine-point photograph scoring system.4 In the system, subject position, facial expression, lighting, background, camera zoom, makeup and styling, multiple views, timing and descriptive information were all assessed.4

The average score was four out of nine, with approximately 40% of posts scoring in the low-quality range. Camera zoom, lighting, timing and presentation of multiple views were the standards commonly disregarded. Low-quality photos were most often seen with rhinoplasty and lip filler treatments, compared with surgical and non-surgical procedures, due to a higher incidence of immediate photographs and selfies.4

The study concluded that before and after photos of cosmetic treatment outcomes on social media were frequently of substandard quality.4 In light of the study, we spoke to plastic surgeon Mr Dean Rhobaye and founder of photography lighting system Clinical PhotoPro Clint Singh to understand why the standards are so low in the industry, as well as their tips on how practitioners can improve their patient photography.

A global issue

Although the study was conducted in the US, Singh believes patient photography to be a global issue. “The problem is industry wide. Clinics follow each other on social media and so trends and industry standards spread. The problem may also be technology-driven, as the use of smart devices is here to stay. Manufacturers are constantly improving devices for photography in clinics and patient management software producers are also making their systems available for smart devices. However, these are for general photography and using them for clinical images requires training, which is often not being provided or actively sought out by practitioners,” outlines Singh.

Distorting images

Achieving good quality clinical photography is pivotal to showcase patients’ results accurately and professionally, noted both Singh and Mr Rhobaye. In a recent study of 30 volunteers, photos with a 12-inch and 18-inch series with a front-facing smartphone camera and a five-foot clinical photography series with a digital single-lens reflex camera were taken. Nasal length was 6.4% longer in the 12-inch selfies compared to clinical photography and 4.3% longer in 18-inch selfies compared to clinical photography, highlighting that image quality can affect the patient’s perception of themselves.5

Singh notes that the introduction of smartphones has resulted in professional clinical photography taking a back seat. “Smart devices have given clinics a quick and easy, point-and-shoot option with no effort to photography needed. Unfortunately, with no training, standardisation or guidance on how to use these devices for the precision needed for clinical photography, we are seeing substandard quality before and afters,” Singh explains.

According to Mr Rhobaye, there are numerous reasons why photography standards are low in aesthetics. He explains, “Time constraints can have an impact – practitioners may feel they cannot commit to spending time acquiring higher-quality images, particularly if they have a busy practice.” 

Furthermore, Mr Rhobaye believes that a common practice on social media among practitioners is publishing non-standardised images that exaggerate the treatment changes. “An example of this practice is the use of perspective distortion in photography caused by taking a ‘before’ image with a wide-angled lens close to the patient. As a result, the perspective distortion warps the facial dimensions in the captured image versus reality, creating an unflattering image. In contrast, the ‘after’ image is taken further away or the distortion is reduced with no warping of facial features,” he notes. Other potentially misleading methods Mr Rhobaye identified include using different lighting, facial postures and tricks with makeup, which worsen the appearance in the before image but flatter the ‘after’. Many professionals are not aware they are intentionally doing this, however, this goes against the Advertising Standards Authority’s rulings as it is misleading.6

Singh also notes that smaller businesses may find taking photographs harder due to a lack of space. He explains, “A smaller business might not have the luxury of bigger premises with a room dedicated to photography. A dedicated room can significantly improve the consistency of before and afters as the lighting can be left in place, and the distances and angles can be replicated.”

Tips for success

According to Mr Rhobaye, practitioners should optimise the duration of their appointments and invest in a quality camera, lens, lighting and accessories. He explains, “Allow time during patient appointments for photography, or another team member can be trained to take the images before and after seeing the practitioner. I would advise practitioners to carefully consider what colour background they would like. Colours, such as light blue, are better suited for medical photography, but also the colour needs to be consistent with the brand image.” 

Mr Rhobaye also recommended that practitioners invest in a 3D imaging system for clinics that want to practise more advanced facial aesthetics. He explained that they have additional benefits to 2D photography for patient education, monitoring treatment outcomes and collecting data for research studies. Producing good quality and accurate photography can be achieved through focusing on factors such as lighting, distances and angles and receiving adequate training if necessary, argues Singh. “Natural light is the biggest cause for the inconsistency in before and afters. The colour and strength of this light changes throughout the day and unless your photography area is protected from the outside by having closed blinds, a camera will react to these conditions, producing images of different exposure and colour. To improve consistency, mark out distances and angles - practitioners should have a consistent environment to photograph their patients in. Invest in training that is specific for photography in aesthetics with mobile devices. The training should consider the requirements of the SEPIA scale, which I think is a much-needed proposed scale for the industry,” he reflects.7

Focus on standardised photography

Patient photography is a pivotal practice for patient education and highlighting accurate outcomes. Mr Rhobaye concludes, “Photography can become complicated when practising at a professional level, dealing with different environments, subjects and lighting. However, in an aesthetic clinic, once the key settings are optimised for the environment, the process becomes, by and large, a ‘point and click’ exercise without having to worry about any further adjustments.”

Improve your clinical photography!

There are many companies out there which can help increase the quality of clinical photography for your practice. Below are just a few to look into:

  • Canfield
  • QuantifiCare
  • RxPhoto
  • Clinical PhotoPro – check them out at CCR!
  • oVio Technologies – check them out at CCR! 

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