How to Read a Before-and-After Photograph
A before-and-after photograph is evidence, and like all evidence it can be presented well or badly. Nothing needs to be faked for a pair of photographs to mislead: a change of angle, a change of lighting, a different expression or a wet versus dry skin surface will do it. Knowing what to check turns a marketing image back into information, and it takes about ten seconds once you know what you are looking at.
A before and after photo is evidence, and like any evidence it can be shown fairly or unfairly. Nothing has to be faked for a pair of photos to mislead you. A different angle, different lighting, a different expression, or damp skin instead of dry skin will do it on its own. Knowing what to look for turns a marketing picture back into useful information, and it takes about ten seconds once you know.
How to Read a Before-and-After Photograph: the essentials
The short version
Same angle, same distance, same lighting, same expression
Same angle, same distance, same lighting, same expression.
Same make-up state, same skin surface, same background
Make up or no make up in both, dry or damp skin in both, and the same background.
A chin lifted or lowered changes a jawline more than most treatments do
A chin lifted or dropped changes a jawline more than most treatments ever will.
How long after treatment, because swelling flatters an early photograph
How long after the treatment? Swelling makes an early photo look better than the real result.
What else was done at the same time, and how many sessions it took
What else was done at the same time, and how many sessions it took to get there.
Individual results vary; a gallery shows what is possible, not what is promised
Results differ from person to person. A gallery shows what is possible, not what you are promised.
The things that change a face without treating it
The things that change a face without treating it
Photography is more powerful than most treatments, and none of the following requires any intention to deceive. Lighting from above casts shadows into every hollow and line; lighting from the front fills them in. That difference alone can make the same face look five years apart in two frames taken a minute apart.
A camera can do more to a face than most treatments can, and none of what follows requires anyone to be dishonest. Light from above drops a shadow into every hollow and line. Light from the front fills them in. That one difference can make the same face look five years apart in two photos taken a minute apart.
Angle does the same work. A camera slightly below the face lengthens the jaw and drops the mid-face; slightly above tightens both. Distance matters too, because a shorter lens distance exaggerates whatever is nearest the camera. Expression is the most obvious of all: a relaxed face and a very slightly lifted one are not the same face.
Angle does the same job. A camera a little below the face lengthens the jaw and drags the middle of the face down. A little above tightens both. How close the camera is matters too, because standing close exaggerates whatever is nearest the lens. And expression is the most obvious of the lot. A relaxed face and a very slightly lifted one are not the same face.
Then there is the surface. Skin that has just been cleansed and is slightly damp reflects light evenly and looks smoother. Skin photographed dry, in the morning, after a night of poor sleep, does not. Make-up in the after photograph and none in the before is the most straightforward version of the same effect.
Then there is the skin itself. Skin that has just been washed and is still slightly damp bounces light back evenly and looks smoother. Skin photographed dry, first thing in the morning, after a bad night, does not. Make up in the after photo and none in the before is just the blunt version of the same trick.
What a well-made pair looks like
What a properly made pair looks like
Standardised photography is a discipline. The same camera, the same distance marked on the floor, the same lighting rig, the same background, the same expression, the same head position and no make-up in either frame. Practices that take results seriously do this because it is the only way to know whether their own treatment worked.
Taking photos properly is a discipline. Same camera. Same distance, marked on the floor. Same lights. Same background. Same expression. Same head position. No make up in either one. Practices that take their results seriously do this, because it is the only way they can know whether their own treatment actually worked.
You can usually tell within a moment. If the background, the framing and the shadows are identical and the only difference is the skin, you are looking at a comparison. If the two images differ in more than one respect, you are looking at two photographs of a person, which is a different thing.
You can usually tell in a second. If the background, the framing and the shadows are identical, and the only thing that has changed is the skin, you are looking at a fair comparison. If more than one thing has changed between the two, you are looking at two photos of a person, which is not the same thing at all.
It is entirely reasonable to ask how a gallery was photographed, and a practice that photographs carefully will be pleased to be asked. It is also reasonable to ask to see a case that did not go as well as hoped. Every practitioner has them, and the willingness to discuss one is more informative than any gallery.
It is completely reasonable to ask how a gallery was photographed, and a practice that does it properly will be glad you asked. It is also reasonable to ask to see a case that did not go as well as hoped. Every practitioner has some, and how willingly they talk about one tells you more than any gallery.
The questions that matter more than the picture
The questions that matter more than the picture
A photograph shows an outcome. It does not show the route, and the route is what you are actually buying.
A photo shows you a result. It does not show you the route taken to get there, and the route is what you are actually paying for.
Ask how long after treatment the after photograph was taken. Immediately afterwards, many treatments produce swelling that temporarily flatters, and a photograph at two days is not the same claim as one at three months. Ask how many sessions it represents. Ask what else was done at the same time, because a result attributed to one treatment is often the sum of three.
Ask how long after treatment the after photo was taken. Straight afterwards, many treatments cause swelling that flatters the result, so a photo at two days is a very different claim from one at three months. Ask how many sessions it represents. Ask what else was done at the same time, because a result credited to one treatment is often the sum of three.
And ask whether that person’s starting point resembles yours. A result on skin with a different tone, a different degree of laxity or a different diagnosis is not a prediction about you. That is not a caveat added by lawyers; it is the honest position, and a practice that says so plainly is being straight with you.
And ask whether that person started anywhere near where you are starting. A result on skin with a different tone, a different amount of looseness, or a different problem altogether is not a prediction about you. That is not a line added by lawyers. It is the honest answer, and a practice that says it out loud is being straight with you.
Take your own, before you start
Take your own photos, before you start anything
The most useful photographs in the whole process are the ones you take of yourself before anything happens, because memory of one’s own face is unreliable in a specific direction: it adjusts to gradual change and then forgets there was any.
The most useful photos in this whole process are the ones you take of yourself before anything happens. Your memory of your own face is unreliable in one particular direction: it quietly adjusts to slow change, and then forgets there was any change at all.
Use daylight from a window, no direct sun, no make-up, a neutral expression, and take front, left and right. Repeat with the same window, same time of day, same distance. It costs nothing and it is the only way you will be able to answer, three months later, whether it actually worked.
Use daylight from a window, not direct sun. No make up. A neutral expression. Take one from the front and one from each side. Then repeat it later at the same window, the same time of day, the same distance. It costs nothing, and it is the only way you will be able to answer, three months from now, whether it actually worked.
Questions patients ask
Why do clinics not always use standard photography?
Why do clinics not always photograph properly?
Sometimes because it takes equipment and discipline that a practice has not invested in, and sometimes because inconsistent photographs flatter. Either way, the consistency of the images tells you something about how the practice evaluates itself.
Sometimes because it takes equipment and discipline they have not invested in. Sometimes because inconsistent photos flatter. Either way, how consistent the pictures are tells you something about how honestly the practice judges itself.
Are before-and-after photographs regulated?
Are before and after photos regulated?
Advertising rules generally require that images are not misleading and that results are typical or clearly qualified, and patient consent is required to publish an identifiable image. Standards vary, so treat a gallery as an illustration rather than a guarantee.
Advertising rules generally say images must not mislead, and that results shown should be typical or clearly labelled otherwise. A patient has to give permission before a photo of them is published. Standards vary, so treat any gallery as an illustration rather than a guarantee.
What if a clinic has no photographs at all?
What if a clinic has no photos at all?
It is not necessarily a warning sign. Some practices decline to publish patient images for privacy reasons and will show consented examples in person instead. Asking is more useful than assuming.
That is not necessarily a bad sign. Some practices choose not to publish patient photos for privacy reasons, and will show you consented examples in person instead. Asking is more useful than assuming.
Should I expect the result in the photograph?
Should I expect the result in the photo?
No. A gallery shows what has been achieved for particular people with particular starting points. Your result depends on your diagnosis, your skin, your healing and how many sessions you have. Expect a discussion about your own likely range, not the gallery’s best case.
No. A gallery shows what has been achieved for particular people, starting from where they were. Your result depends on what is actually wrong, your skin, how you heal and how many sessions you have. Expect a conversation about your own likely range, not the gallery’s best day.
Is it worth photographing myself?
Is it worth photographing myself?
Yes, and it is the single most useful thing you can do before starting anything. Consistent daylight, no make-up, neutral expression, three angles, repeated at the same interval. It is how you will answer the question later.
Yes, and it is the single most useful thing you can do before starting anything. Daylight, no make up, neutral face, three angles, repeated the same way later. That is how you will answer the question afterwards.
Where to go next
Talk it through with a physician first.
Every plan starts with an assessment of your skin, your anatomy and what you actually want to change.
This page is general health information, not medical advice. It cannot tell you whether a treatment is right for you. Approved uses, risks and results differ from person to person, and product labelling changes. Ask us at Dermatology and Laser Centre about your own situation, or make an appointment, and seek urgent care for any serious symptom.
