As some of you know I am adamant about taking photos without flash. It completely skews the image away from reality.

While photos are not the best to judge results they are by far and above the preferred format in which most people perform research into hair restoration. Not everyone can travel thousands of miles over the course of several months to meet dozens of patients from various docs. Yes, photos are here to stay and video will eventually come on strong as well.

With that in mind I have been a crusader of sorts to encourage not only clinics but patients as well to take the best photos they can. Some of you may have read my posts where I say that flash photography literally doubles the perceived density in the hairline. But what about the top and the donor area? It actually can have the OPPOSITE effect. While I noticed this I wasn't too sure as to why.

I recently wrote to a friend of mine that is a professional photographer. He hangs out of helicopters and all kinds of crazy stuff to get the perfect shot and has been published worldwide. He is also a HT patient (not one of H&W) so he understands, and agrees with, my points regarding flash. Below is his description of why flash is bad.

"Hey Joe,

Good to hear from you. I have limited time as I am working on some pretty
tight deadlines on stuff, but wanted to give an answer to your question.

When dealing with light, the angle of incidence equals the angle of
reflectance. That is why you are correct that a flash on the hairline will have the opposite effect as it does when it hits the top of the scalp or donor area at 90 degrees. The hairline is at a slope so to speak where the head begins it's curve back...so the light from the flash is hitting the hairline at say 60 degrees. Because of this the hair, if there is any, will cast shadows directly behind the hairline giving the illusion of more hair. Remember that these shadows are falling away from the camera at an angle, unlike the way they do when you shoot the top of the head or donor at 90 degrees. In addition, when shooting the top and donor at 90 degrees, the flash will reflect off of the scalp because of it's angle of incidence giving the illusion of less or more diffuse hair."

In summary, what he is saying is that while the use of flash may make the image look better overall it is doing everyone a disservice by not representing was is present in reality, or in the case of some results, what is NOT present in reality.

I encourage all clinics to stop using flash photography. It is misleading to the patients and can give a false sense of hope. When taking photos, do not use a flash in the before photo of the top or the back then use no flash in the after. The flash makes the image appear to show LESS hair in the before than what is really present thereby making the final result appear just that more impressive (density, coverage etc.).

Do not take before photos of the hairline WITHOUT flash and after photos WITH flash. While this may show the real story before surgery the photo will show literally DOUBLE what is present in reality in the final result.

Here is a hairline example. The pic on the left was taken without flash. The one on the right is the same patient about ten seconds later with flash. The difference is obvious.



Both techniques have the same effect. More hair as a final result from surgery than what is present in reality.

The above goes for patients too that are documenting their progress. I know it's hard to be 100% consistent. Our daily routines do not allow for this but the more you do to TRY and be consistent the better you'll be serving those that are following your progress.

I know that this post will not eradicate the issue. Some will falter, some won't care but if some of you learn from this and apply it to what you see in photos perhaps it will give you a better sense of what is really going on and if some of you actually speak out about it then perhaps you can help to initiate change by getting clinics to pay better attention to their photos.

Rant off.

__________________
I am employed by Hasson & Wong, on salary, not commission. My opinions are my own.

Hasson & Wong-The More You Look The Better We Look.

Dr. Hasson and Dr. Wong are members of the Coalition of Independent Hair Restoration Physicians

Great post Joe.

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My Hair Loss Weblog

Joe,

Very interesting post. Let's just hope this information does not fall into unethical hands or certain clinics will be doing lots of flash photography for the hairline :-)

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i took these pictures same day (5 days before surgery with dr.keene).
as you can see my first pic is done outside with sun light (and u cant notice any hairloss that i have) while second pic i did at my home (and u can see what kind of hairlos i have.
This is the reason why i dont believe watching pics from docs sites or even from some people who are posting on HT forums.
I think everyone should be honest and show pictures (pre and post op) made with same light,same angle and same hair lenght.

pic 2

Attached Images

zzzz2.jpg (28.8 KB, 261 views)

Pat,

Too late

Maki,

My point exactly and I've been saying this for years now.

__________________
I am employed by Hasson & Wong, on salary, not commission. My opinions are my own.

Hasson & Wong-The More You Look The Better We Look.

Dr. Hasson and Dr. Wong are members of the Coalition of Independent Hair Restoration Physicians

A couple of points:

Why do we assume the picture with the worst result is the "gold standard"?

Two pictures of the same person that results in two perceptions is called "reliability" not "validity". Thus, each photo is valid under its own conditions.

More specifically, reliability would be the consistency in which you see your results. Validity is what your results appear to the viewer at a given time. This is a well know scientific concept.

That is why it is best to get both views IMO.

__________________
Dec. 2004 - 1938 Grafts via Strip
Feb. 2009 - 1002 Grafts via FUE

While it is a well known concept in science Hairhope it does not apply to the issue of HT photos. Science has a funny way of being considered "science" only if the conditions that define real science are controlled. The use of flash is the easiest way to control the outcome of photos.

The problem with your angle is that I have not met a single patient that has a flash bulb going off all day every day while they go about their business. I doubt anyone else has either. What I have met are patients that on a daily basis have to sit under flourescent office lighting (pretty good indicator of what's really going on with the density) which is a good example of how to consider taking photos. That's what we do.

__________________
I am employed by Hasson & Wong, on salary, not commission. My opinions are my own.

Hasson & Wong-The More You Look The Better We Look.

Dr. Hasson and Dr. Wong are members of the Coalition of Independent Hair Restoration Physicians

Good post. As a matter of fact, if you really want hair transplant results in photos to be honest, put the AVERAGE result photos on your website. Cherry picked results plastered on a doctor's website are just as unethical and deceiving don't you think?

Trust your own eyes in person. Don't rely on what is coming from these clinics. It is filtered information to say the least.

NO clinic is going to show their patient's results in the worst case scenario. The TRUE honest photos come from the patients that are not trying to shill for their clinic.

H&W are the most well documented clinic on the internet. There are numerous 3rd party photos available throughout this site and virtually every other hair transplant related forum on the internet.

Here is a link on their website of the personal blogs:

http://www.hassonandwong.com/patient...nt-stories.php

You will notice if you take the time, that it includes average patients - average laxity, average shaft thickness, etc.