An education regarding photos.

[Jotronic]

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.

[troy]

Great post Joe.

[Pat - Community Publisher]

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 :-)

[maki8787]

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.

[maki8787]

pic 2

[Jotronic]

Pat,

 

Too late

 

Maki,

 

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

[HairHope]

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.

[Jotronic]

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.

[Guest Landen]

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.

[UGLY MAN 4 LIFE]

Originally posted by Landen:

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_gallery/hair-transplant-stories.php

 

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

[Guest Landen]

Information will always be filtered when money is involved or something is to be gained. The more ethical doctors will disclose more info but not all info. Best-case-scenarios will always be displayed, and poor results will always be down-played. Strip doctors will not show their not so aesthetically pleasing results and poorly healed strip scars. FUE doctors will, likewise,showcase the premier patient results and downplay potential scarring. Patients are not armed with all the information to make an informed decision in this serious, life-changing cosmetic procedure. That is the bottom line.

[Jotronic]

Landen,

 

Most of what you say is correct. This is why I posted this in the first place, so that viewers can start to understand what they are seeing. The absolute best documentation is shown by the patients because they are in a position to show all real world scenarios. I did this on my personal site by showing my hair straight out of bed, wet from the shower, in the sun, etc. Unfortuantely, the consistency factor is not very high with these photos so one needs to consider this as well. Overall, the number of photos shown by a patient can be used to give an overall impression of what you are looking at.

 

Clinics however aren't in a position to do this. What clinics can do is take some steps to show the results in a more realistic setting. Like I said, people don't walk around with flash bulbs going off around their work 24/7. Take our clinic for example. Overhead flourescent lighting like that found in any office environment. It's the worst indoor situation one can find themselves in when surrounded by peers. These pics should be taken as consistently as possible but no matter what one does the before/afters will never be perfectly matched. It is difficult to say the least.

 

What one needs to consider when looking at a clinic is the conistency with the work. If a clinic has a small number of patients that are willing to show their results on the clinic's gallery then you need to wonder what is going on. If they have quite a bit then you get a feel for the overall level of competence of the clinic. While the actual number of patients in any clinic's gallery is only a fraction of those that have walked through the doors it does help. Even though we have more results in our gallery than most it is not as many as we'd like. We've got some results that simply have us with our jaws on the ground but they patients aren't always excited about "outing" themselves online.

 

Fortunately this is compensated for by the roughly eighty some-odd patients or more that have documented online, either in personal blog style websites or in dedicated threads on the various forums. This is far more than any other clinic. It's hard to explain the exact reason why this is but whatever the reason we're very grateful for their willingness to share. We feel that this has helped to change the industry in even a small way. This behavior is something that is new to the industry as it has only become "common" to expect this from the better clinics in the past few years.

 

Above all in person inspection is the best but unfortunately this is not always possible. See patients if you can, always.

[Guest Landen]

Jotronic,

 

Nice reply. What you say makes a lot of sense.