“BEFORE and AFTER” – Believe It or Not?

The success of the aesthetic medicine, like fashion industry, depends on positive visual perception by the target audience. Not surprisingly, the representative imagery has been a subject to many manipulations aiming to enhance a favorable impression and desire for perceived rewards. In reality, however, the outcome may be very disappointing and far from the results projected by the image makers.

Without a doubt, there are many genuine and impressive results achieved by devoted professionals who must often go beyond the standards of protocols to deliver good results. Beyond that, however, I do take issue with those who go out off their way to attract potential customers by using deceptive techniques of imaging. The image manipulations are not very sophisticated and do not necessarily need cooperation of the subjects. Adjusting light conditions, image size, postures, intentional tightening of muscles or similar maneuvers are designed to enhance, convince and deceive.

One could ask whether it is possible to manipulate visual perception to fool the eyes of result seeking public? Is it possible to force mistaken interpretation of what’s appear to be obvious? This question was answered many times over the last several centuries by artists, psychologists as well as by “magicians.”

It is very easy to trick our brain into making an incorrect interpretation of data received from the senses. This misinterpretation of sensory stimulus results in optical illusion.

Optical illusion = Mistaken Judgement

Optical illusion occurs because we don’t always know what we see but we tend to see what we know from experience.

We interpret the above image as two overlapping triangles and three circles even though there are none – only three angles and three incomplete circles. Based on our familiarity with simple shapes and objects our interpretation “adds” missing parts rather than reports the exact picture.


The illusions extend beyond two dimensions; light manipulation allow us to “recognize” relationships in 3D.

Light direction is a cue for 3-D recognition and our perception depends on the choice of concentrating our attention on particular feature. What is concave coud be also seen as convex.

What Light and Shadow can do to our interpretation of reality is frequently mind boggling! Certainly, it could be an entertaining experience but these maneuvers are frequently used as a tool of intentional deception for the purpose beyond entertainment.

On image 1, the fields A and B clearly appear to be of different gray intensity. Image 2 connects both fields revealing our gross misinterpretation!

We must learn to see what is actually in front of our eyes and not what our brain works out for us.


Now, let’s try if our perception of real life examples can be altered and make us see non-existing changes. The following images of “Before” and “After” where obtained by me within several seconds of each other when the only change “in-between” was adjustment of the light direction and intensity.

Now you have it………………………now you don’t!

Naso-labial folds appearance in different light

Another “procedure” that erased the naso-labial folds

Here, one can claim that the newest (still imaginary) skin tightening “procedure” can take away even the deepest folds.

Above, not only wrinkles and folds faded away but the jowls look so much better!


“Dark circles” below the eyes? No problem, we got it covered too. Here are few examples of our expertise.

Dark circles can disappear equally easy with manipulation of light

The “results” appear very convincing to those who are bothered by this common sign of aging and seek a remedy.

Another example of non-existing “rejuvenating procedure”


Are you bothered by cellulite? The latest technology can get rid of your stubborn and unsightly cellulite dimples!

Little light adjustment and…voila!

Patient with common age-unrelated cellulite who may be deeply disappointed with other procedures       may be very impressed with the degree of improvement seen on these “Before and After” photographs even though these were made within several seconds of each other.

Near complete “disappearance ” of cellulite


In reality, the above examples come from our office, the VISAGE MedArt in Nashville with full cooperation of our patients. I can assure you that nothing was done between “Before” and “After” images except for the adjustment of light conditions. We did this exercise for educational purpose to help our patients to sort through thousands of images posted on internet.

Below are few similar, random examples from internet; some posted on the websites of the providers and some from marketing pages of the manufacturers of cosmetic devices.

A case of instant cellulite “reduction.”

The direction of light in “After” image gives impression of successful treatment of cellulite


“Double chin” can ruin any picture if taken from a wrong angle. Many of us would happily undergo a pricey procedure just to get rid of that extra chin.

A dramatic “reduction” of “double chin”

Actually, nothing is really needed to show these incredible results except a simple chin extension.

Similar results, similar head position, similar claims:

Instant reduction of “double chin” with appropriate positioning

Cellulite and fat “reduction” with…light.

This image, owned and published by Lipotherapeia has even a copyright written all over it. As you can see, the light direction attempts to fool your eye to see a very convincing and impressive results that can not be verified.

One more image from the manufacturer’s marketing portfolio. Whatever the results were, one should question their motives when looking at the extreme difference in light direction.

I am very puzzled by the publication of these images in marketing material. Did the obvious escaped the publisher or they assumed total ignorance of the prospective patients?

It would be either childish or utterly unimaginative to believe that the authors of all these photos are unaware of physical aspects of light perception and illusions it may create. I suggest that the reason is not only an attempt of selling false or exaggerated promises but also patronizing assumption of ignorance of their audience!

I could show endless examples of mistaken perception of images subjected to different light direction or subject’s position. These simple maneuvers are common tools used in marketing to create an illusion of non-existing improvements, giving patients a new hope and, consequently, enticing them to seek the treatment.

I cannot claim much authority for myself, but I think that there is something of a gold standard in ethics

and morality in the conscious mind. To know the difference between what you have right to do and what is right to do is to adhere to the standards of ethical conduct. Condoning this behavior, propagating falsehoods or standing idle is to participate in something that is exactly opposite to the proper conduct in medical profession.

After 27 years in academic and clinical medicine it was not easy to discover that the new direction I have chosen 10 years ago is so dramatically different from medicine I know. It is riddled with deception, arrogance, and self-serving marketing for profit. I feel an obligation to be a patient’s advocate and provide them with arguments that will hopefully help them to distinguish reality from intentional deception.