JUDGING
BEFORE AND AFTER PHOTOS
Ó PJWMDPA
The age of the microchip
and computer electronics has been very good to medicine and to patients.
Digital photography and medical imaging systems can give patients a
very good idea of how they will look after CERTAIN TYPES of surgery.
This is especially true of operations like hair transplants and nose
and eye jobs. However, imaging systems cannot be relied upon when it
comes to liposuction. A nose-job imaging is usually more reliable because
there is very little fatty or muscle layering on the nose, which is
mostly skin, cartilage, and bone. A nose job consists chiefly of working
with the nose skeleton of bone and cartilage. These are all relatively
thin and predictable layers, and thus, the result of digital imaging
can be more realistic. Liposuction is different. Unlike the nose, on
which the surgeon can operate in all planes, in the case of liposuction,
a surgeon can remove only the fat that lies between the bone and muscle
and the leather layer of the skin (dermis).
Surface analysis only puts limitations on imaging. Current imaging of
liposuction patients cannot detect protruding hip bones or thigh skeletons.
Today’s imaging cannot tell the doctor how much muscle and fat
are present over a relatively enlarged or small skeleton. The fatty
compartment may also be of such a size that it is undetectable or unpredictable
using visible light photography. At present, ultrasound, CT (computer
tomographic), and MRI (magnetic resonance imaging) scans are not practical
to create the digital images for surgeons to display "before" and "after"
liposuction results. Until better imaging systems are available, patients
are best served by a hands-on physical
examination of the areas to be suctioned from
their surgeon, with a nurse present, in order to see the realistic extent
of the fat to be removed.
Unfortunately, in this
digital age, some doctors and their hired public relations teams tend
to "manufacture" their own photographic "results."
Some have been known to digitally copy them from other doctors or digitally
modify their own patients' photos. The Web site author believes that
patients should request assured that the surgical results shown to them
by their surgeon-to-be have not been digitally altered (by computer
chip) or mastered.
Many surgeons like to
show their patients computer renderings of how they will look "before"
and "after." Unfortunately, these same computer devices are may be used
to modify the surgeon’s true photographs of their real patients.
The computer devices, of course, may be programmed to show patients
how only a "good" result would look. Surgeons who have performed a significant
number of liposuction procedures would hopefully have on hand Kodachrome®
or other brand slides or Kodak prints (on labeled photo paper) of their
work. It is difficult to digitally alter or master slides or prints
made from negatives. The Web site author believes it is best for patients
to request to see copies of pictures of patients that look very much
like they did and will "before" and "after" surgery. First of all, the
patient would then be able to judge results from true-to-life pictures
rather than from something fictitious, fake, or modified. Second, the
patient will have a true idea of how the doctor has performed in past
liposuctions based on his/her ability to come up with a picture of a
similar patient and to show a good outcome. Again, to see reality, the
picture should be of a type that cannot be easily "fixed" or digitally
mastered.
Before your liposuction
is performed, it may be wise for you to take pictures of yourself (timer
delay, mirror, or another photographer) for your own records so that
you can determine whether any ripples or bumps present following the
liposuction were present before the procedure. Remember that liposuction
is not guaranteed to remove every ripple or bump, but it should not
make new ones if you have a very elastic skin envelope. Liposuction
should, however, provide the benefit to a patient of reducing the size
of a given area in a fairly uniform fashion. Most good surgeons will
have photographs taken of you prior to the procedure. The best way to
judge the result of a cosmetic procedure is by the use of photographs.
Here a picture is worth a thousand words. For the highest quality and
to be sure of "undoctored" results, pictures are best taken
on Kodachrome® or other slide film. Slide film still
contains a far greater number of pixels of information (about 16 million),
as opposed to current digital cameras or digital recordings (about 4
to 6 million for more expensive digital cameras in 2002). Also, as we
discussed before, slide and print film (made from negatives) cannot
be easily manipulated or "doctored" to fake a result.
Any doctor who performs
a liposuction without taking photographs before the patient has been
treated should raise some concern in the patient. A doctor's best way
to document a cosmetic procedure is by taking photographs. These days,
almost any camera can take acceptable pictures for documentation purposes
in liposuction. Even a $10 disposable camera with built-in flash will
do! Most of today’s cameras are almost foolproof, especially at
the distance at which liposuction pictures are shot. Four views (front,
back, right, and left sides) are a recommended minimum. Also,
once the doctor marks the areas to be treated on the patient (before
the liposuction), it may also be wise for the doctor to repeat the photographs
to show the areas to be treated.
