The Last Word: Mirrors vs Photos

By Dr Manav Bawa / 25 Jan 2023

Dr Manav Bawa debates the use of photos over mirrors when assessing patients

When conducting a consultation, do you usually get your patient to look in a mirror while discussing your assessment? If so, do they see exactly what you see? I’ve found that the answer to this is usually a resounding ‘no’.

With this in mind, have you considered taking photos of your patient and assessing them together in your consultation? This could be used to educate your patients, as well as discuss treatments and their justification. Since implementing the use of images in March last year, I have lost count of how many times patients have looked at a picture I have taken and say they had never noticed an area I had pointed out – even though they didn’t when they looked at themselves in the mirror earlier during the same consultation.

I believe that using patients’ photos can be a very powerful way of holistically examining your patients and showing them all the areas you could help with.

The benefits of using mirrors

Asking patients to use a mirror during a consultation is of great value, as it is a quick and easy way for patients to express what areas they are concerned with. They will usually be familiar with the process of examining themselves in a mirror at home, with patients commonly saying they ‘pull back’ their cheeks at home to obtain a lift, as an example.1 This is a great way to start to work out what your patients’ concerns are, and what they would like to achieve.

Improving patient insight

However, it has been identified that patients’ self-perception can be different when looking in a mirror compared to a photograph.1 Rather, when being shown a mirror image, people see what they want to see. This can be positive or negative, however, it definitely means that it is a more subjective process.2 Alternatively, when we look at a picture, we tend to see things in a much more objective way. One of the reasons is that our faces are asymmetrical, and a photograph shows this differently when compared to looking into a mirror.2 A good example of this is a patient seeing nasolabial lines in the mirror, when in a photo of themselves, they can easily see the hollowing of the medial cheek, especially from different angles. This is one reason why it can be beneficial to use imagery as it could be easier to demonstrate to patients what is really causing the concerns they have.

Therefore, while the use of a mirror can be a good starting point for the patient to communicate concerns, in my view, photographic imagery is important when getting practitioner perspective across.


Personally, I have found that one powerful technique is to draw on and annotate your patient’s image, which I do using patient management system Pabau on my iPad. Drawing where there are treatable areas, volume loss, pigmented areas, for example, can bring attention to that indication. Therefore, I find that it helps to educate the patient on the reasons why treating this area could create an optimised result, getting them to understand your treatment plan in more depth. You could also consider listing the treatments on the image as well as the products used. Once the image is saved in the patient’s records, it can help to plan once the patient has left the consultation. This is extremely helpful in a very busy clinic, or where a practitioner writes their notes at the end of the day.

While taking photographs, you should ensure you take images from all angles and several expressions to show dynamic movements that could be potentially treated. It is important to try to help our patients see themselves in a three-dimensional way, as this is how we see each other, and using photographs can certainly help to achieve this.3

Arguments against imagery

Of course, there are many reasons why practitioners currently may not use images. Throughout my time using this technique, I have heard the following arguments.

“The process takes much longer”

This may be true, however, taking the time to educate and justify your treatment plan will create trust, and patients will understand what is causing their original concern.

“Patients don’t like seeing themselves in photos

You should always ask permission to take and use photos, along with an explanation as to why this would be helpful. If patients strongly refuse, there could be an element of body dysmorphic disorder (BDD). If this is suspected, the practitioner should explore it further.

“My consultation is already comprehensive” 

As professionals, we continue to evolve, and perhaps this could provide a small positive improvement in your patient journey. Try it and see if it helps – if it doesn’t, nothing is lost. If it does, it could help create much larger treatment plans, and therefore more transformative results.

Try imagery

The patient journey is something we continually strive to enhance, and is one of the things that makes us different from our competitors. Using photos of your patient in their consultation to educate is an important part of their journey, as it will help them to understand their own ageing process better, as well as understand why you recommend a specific treatment plan for them.

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