Picture Imperfect: Unmasking Plastic Surgery Before/After Photos

You can navigate between aspiration and deception in plastic surgery portfolios.



  • Plastic surgeons often use deceptively edited before-and-after photos to advertise their work.
  • Studies show that most before-and-after photos on plastic surgery social media are manipulated.
  • Lighting, facial expression, makeup, and hairstyle in before/after photos influence perceived outcomes.

In an era of image-driven social media and the relentless pursuit of aesthetic perfection, plastic surgery has become a booming industry fueled by the promise of transformation. Before-and-after photos have become a staple of plastic surgeons’ social media profiles, highlighting the doctor’s skill and aesthetic judgment.

However, a closer inspection of these photographs reveals a disconcerting trend: Subtle editing techniques can create the façade of flawless outcomes that may not accurately represent the reality of a practice’s procedures.

A previous study by Vaca et al. found that 97 percent of the top before-and-after Instagram posts associated with plastic surgery hashtags favored visual enhancement of the post-surgical result. Specifically, they found that changes in lighting, facial expression, head position, makeup, and hairstyle between pre- and post-surgical photographs significantly influenced perceived outcomes.

Lighting can blanch skin imperfections, a new hairstyle can hide facelift scars, and smiling can lift the cheeks and minimize jowls. These are just a few techniques that may overstate the true effects of surgery. A recent study by Soares et al. finds that photos taken in the immediate post-surgical, or “on the table,” period may inadvertently suggest the finality of results. In contrast, the reality is that the healing process after aesthetic surgical procedures extends over months or even years.

So why are plastic surgeons posting images that can potentially mislead viewers? It may be due to pressure to continuously create content for social media. Vaca et al. found that Instagram accounts with photographs that had a higher degree of post-surgical manipulations had more followers, suggesting that “photographic misrepresentation is rewarded by greater user engagement.”

Many of us have succumbed to social media algorithms, which amplify content with greater entertainment value. In the realm of aesthetic surgery, this may correlate to more dramatic before-and-after comparisons. While there is educational value in posting “on the table” results or post-operative photographs that are not taken under a nearly identical setting to their pre-operative counterparts, surgeons should incorporate disclaimers to ensure that the outcomes they present are not misinterpreted by viewers.

Deception in before-and-after photos can be especially detrimental to prospective consumers. The seemingly perfect transformations depicted in edited before-and-after photos create an illusion of instantaneous, effortlessly perfect results, fostering unrealistic beauty ideals. Prospective patients exposed to these idealized images may internalize impracticable expectations, leading to dissatisfaction with their own progress and, in some cases, contributing to heightened self-criticism.

As such, viewers should be urged to interpret before-and-after photos with a skeptical lens. It is important to be cognizant of potential digital enhancements, lighting effects, angles, posture, and the inclusion of makeup or jewelry, all of which can create a misleading portrayal of surgical outcomes. By fostering a critical eye, viewers can empower themselves to discern between authentic transformations and manipulated depictions, ultimately promoting a healthier and more realistic understanding of aesthetic surgery outcomes.

As we navigate the digital landscape, it is imperative to recognize the impact of misleading visuals and to advocate for a more transparent and authentic portrayal of the plastic surgery experience. This can help foster a culture that prioritizes mental well-being alongside physical transformation.



Vaca EE, Perez MM, Lamano JB, et al. Photographic Misrepresentation on Instagram After Facial Cosmetic Surgery: Is Increased Photography Bias Associated with Greater User Engagement? Aesthetic Surgery Journal 2021;41(11):NP1778-1785.

Soares DJ, von Haven HN, Yi CH. #TheUglyTruth? A Qualitative Evaluation of Outcomes Photography on Instagram: Introducing the SEPIA Scoring System. Plastic and Reconstructive Surgery Global Open. 2022;10(8):e4464.


Read the original article on Psychology Today, co-authored by resident Dr. Amir Hakimi.


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