The IMPORTANCE of accurate representation

[JoeTillman]

Over the past ten years I helped set the standard in the industry for how photos should be taken as well as the use of HD video for documentation. It's been nice to see how some clinics have adopted the same protocols for their own documentation but unfortunately clinics that avoid the use of flash photography are still far into the minority. I've spoken about this issue for years and while I always get the posts of support and agreement from fellow forum members there is zero accountability held to clinics that still use flash. To recap the reason why flash is not helpful...

 

1.) Flash makes hairlines look at least twice as thick as would be seen in reality.

 

2.) Flash before a procedure can make the crown (at the right angle) seem half as thick so the after image will look amazingly full. I once took a photo of my own crown with a flash and it looked shockingly thin then took a second photo a few seconds later and it was such a big difference for fullness that I could have presented it as a 3000 graft before/after presentation!

 

3.) Flash makes coarse hair look fine, particularly at the exit point of the scalp in the hairline so ultimately the hairline itself looks softer and less harsh.

 

I would like for other forum members to help influence member clinics to stop the use of flash photography. Maybe Gillenator, Matt1978, Mikey85, KO and other members will do more than simply agree with me online but take it a step further and hold presenting clinics to task. When photos with flash are posted, speak up, say something so that eventually maybe they'll change their presentation format. This is not to say that the clinics that use flash produce bad work, far from it, but it is the responsibility of clinics to present their work in a manner that reflects what one would see in person as closely as possible.

 

Below is an example I posted several weeks ago of my own hairline. It is a simple before/after taken a few seconds apart and my hair is damp. It shows the transition quite well. I may post more as time allows to further demonstrate this issue.

 

What say you, fellas? Are you going to recommend clinics that use flash after some of you already agreed with me in the past?

 

[rev333]

Consistency in photography requires precise angles and consistent lighting and distance, which can be a challenge but Hasson and Wong have the most consistent before and after patient photography documentation in the business

[JoeTillman]

Consistency in photography requires precise angles and consistent lighting and distance, which can be a challenge but Hasson and Wong have the most consistent before and after patient photography documentation in the business

 

Thank you:) The challenge there was getting consistent color backgrounds and white balance but that has improved, over the past year especially. I've been working with Rahal to set more rigorous standards but to be honest there wasn't really anything to change. I had some preconceived ideas about how Rahal was taking images but once I arrived at the clinic in Ottawa and saw how things were done I realized that the set up is solid (and with no use of flash). There is a dedicated photo/video room and the background reduces the issue of color saturation and white balance challenges. I love the set up! Both clinics have solid photo routines but that is not the point of this post or thread. The point is to bring to light (pardon the pun) about how NOT to take photos and the impact it has on perception. Isn't perception the whole point of this? Now I'm asking other members to step up and push the issue that some of them have agreed with me on before. I've read member postings that talk about how this clinic or that clinic has great documentation but then I see obvious signs of flash being used and I shake my head because I know that the result looks nothing like the photos. Does the forum member making these comments realize that flash is being used?

 

A clinic does not have to have a dedicated photo/video room to get consistency. It takes finding one spot and insuring that the lighting is adequate and keep taking photos at the same angles. Don't use a flash to compensate for photos that seem dark, just crank up the ISO or the exposure or buy a DSLR and pair it with a large aperture lens of at least 2.8 or larger (larger actually means a lower #). Some point & shoot cameras will suffice and several models now have fast large aperture lens built in so perfect lighting is not necessary as long as it does not fluctuate.

 

I also think that clinics should not be relying on patient submitted photos too much as I see this far too often. Patients will use flash far more than clinics will but they just don't know any better. Many times it is a photo that was taken candidly out and about and while these are great lifestyle reports they don't show what the result really looks like. A patient just looks at the picture and says, "Wow, my hair looks really good here" and they send the photo in to the clinic. The clinic thinks it is a great marketing opportunity and they post the pic along with the before photos and everyone "oohs" and "ahhhs" over the result. It's ok to use patient submitted photos every once in a while but it should not be the primary source of results documentation. It is far too inconsistent and does nothing to insure reliable representation.

[SADbutTRUE]

great post joe

[lorenzo]

You are asking doctors and clinics to post pictures that are more realistic therefore in most cases less flattering? This has been going for years and many posters especially new poster are unaware on how lighting, angles and other aspects can take an average result and make it an inaccurate above average result. As Joe will attest Hasson and Wong has been following a high standard of both videos and pictures for many years. Although in many cases less flattering if the main objective is to show a much better transplant than it actually is. The main objective should be to show an honest realistic and ethically correct result. I will confirm that the photos you see from H&W are based on being accurate and if you see the person in real life he looks much better, in all cases. Very few doctors have followed H&W lead in this and actually they have no reason to. Many clinics post inaccurate photos and posters start complimenting there is no need to want to improve the quality and take a risk that the final product loses the wow effect, even though in my opinion its the ethical thing to do. So I don't believe you will convince many clinics to follow a high standard in posting pictures.

What we can do as posters is to ask the forum to give us a rating system of accuracy of photos. This will be at the top of any photos posted by clinics with reasons why you believe it is not accurate. Maybe a clinic doesn't know but once they realize that posters don't feel the pictures are accurate then maybe this would make them change.

This is my opinion.

[KO]

I wish this forum would take a harder line to ensure the recommended physicians post better quality photos: front, back, sides, and top, both before and after under good lighting. In many cases, Bernstein only posts frontal shots, Erdogan posts wet before, dry after, Panine just posted some shots that don't show the top. Those are just the ones I remember.

 

It's very frustrating to see this over and over again.

[Rootz]

Absolutely agree that better pictures should be taken and posted, and we're not just talking about flash either. I remember very recently a clinic actually posted photoshopped stuff here... they got called out because the editing was pretty obvious. Makes you wonder how many of the pictures shown here are intentionally done in a way to deceive people. I would venture to say most. I mean, all clinics will have the tendency to post what puts them in the good light, but I think in general it's a bit out of hand. There are lots of very one sided results posted that come across as infomercials in terms of presentation. The issue of flash is rarely a topic of discussion here not just because most people are unaware, but also because there tends to be so many other issues with the pictures: blurriness, bad lighting, poor resolution, limited angles, and biased display (i.e. post op hair impeccably styled, pre op hair combed up and apart) come to mind.

 

There are many variables when it comes to taking pictures unfortunately. Maybe if clinics just got into the routine and recording videos (when able) it would simplify things.

[JoeTillman]

Hey Lorenzo,

 

I know how it's done there, my friend:) I'm the one that set the standards to begin with, not the clinic. Before I started there they were using flash just like everyone else.

 

I'm not asking other clinics anymore. I'm asking other forum members to start speaking up about this to help force the issue. You're right, though. When posters are complimenting the photos that should have been taken completely differently then there is no reason to change.

 

Rootz & KO,

 

I'm glad you guys chimed in. You're both right and those are issues that also affect the quality. I think if we take one thing at a time maybe some change can occur. The flash issue is the biggest one because it makes more an impact than if an image is slightly out of focus, etc. I mean, how many patients have flash bulbs going off around their heads 24/7? None. So why should there be a flash for a result photo? The whole point of a results photo is to show the naturalness so what is natural about a flash bulb? I agree with KO. I wish the forum would take a stronger stance on this but who should police this? Three guys moderating a busy forum or the dozens of guys that post every day? I don't think Bill, Blake and David have the time to do something like this. You guys are in a better position to.

[JoeTillman]

Hey Lorenzo,

 

I know how it's done there, my friend:) I'm the one that set the standards to begin with, not the clinic. Before I started there they were using flash just like everyone else.

 

I'm not asking other clinics anymore. I'm asking other forum members to start speaking up about this to help force the issue. You're right, though. When posters are complimenting the photos that should have been taken completely differently then there is no reason to change.

 

Rootz & KO,

 

I'm glad you guys chimed in. You're both right and those are issues that also affect the quality. I think if we take one thing at a time maybe some change can occur. The flash issue is the biggest one because it makes more an impact than if an image is slightly out of focus, etc. I mean, how many patients have flash bulbs going off around their heads 24/7? None. So why should there be a flash for a result photo? The whole point of a results photo is to show the naturalness so what is natural about a flash bulb? I agree with KO. I wish the forum would take a stronger stance on this but who should police this? Three guys moderating a busy forum or the dozens of guys that post every day? I don't think Bill, Blake and David have the time to do something like this. You guys are in a better position to.

[lorenzo]

Joe you don't have to repeat yourself.

[densedream]

I don't think it's that hard of a policy to implement. To be a member of this forum you have take pictures like this... and give the clinics the information on how Dr. Hasson and Wong present pictures. You don't need to be a professional photographer or know any special software. If they don't comply, they can't renew their membership or however the business side of this site is ran. There definitely need to be standards in place for documentation since photos can vary widely. Doctors that refuse to do it this way must have some quality issues to hide.

[JoeTillman]

DenseDream,

 

Your avatar kills me:) Adding a standard list of angles that are required is one way to go about it. Most do this already however and it is only a few holdouts that don't. I can see how a hairline job doesn't quite require a crown shot, etc. but standards are necessary for sure.

[JoeTillman]

DenseDream,

 

Your avatar kills me:) Adding a standard list of angles that are required is one way to go about it. Most do this already however and it is only a few holdouts that don't. I can see how a hairline job doesn't quite require a crown shot, etc. but standards are necessary for sure.

[Mickey85]

All clinics should be using video documentation, parting the hair, doing comb throughs, even wetting the hair(post-operative, not pre-operative) and showing a plethora of angles. Photo-only documentation can hide things and is inexcusable in this day and age in my opinion. if a clinic is truly confident in their results, video documentation helps them stand out from the pack and is much much more convincing.

[FUE2014]

Yeah, I pay little attention to photos, lets see some video results like Dr Lorenzo....like his results, it is in fact him that is setting the standards in terms of accurate representation.

[JoeTillman]

All clinics should be using video documentation, parting the hair, doing comb throughs, even wetting the hair(post-operative, not pre-operative) and showing a plethora of angles. Photo-only documentation can hide things and is inexcusable in this day and age in my opinion. if a clinic is truly confident in their results, video documentation helps them stand out from the pack and is much much more convincing.

 

Hi Mickey85,

 

I agree but that is not an issue of laziness. When I first introduced the idea of HD video for documenting hair restoration results it was a huge undertaking. I had to learn about HD codecs for converting files and compressing them as much as possible without losing the quality of HD. It took forever to take the file off of a TAPE and learn how to convert it to something that could be edited. The file sizes were massive too. Roughly 8 years later it is much easier and cheaper BUT most clinics just don't know how to shoot a short video and edit it to make it presentable even on the most basic level.

 

I would love for video documentation to be a standard but baby steps should be taken to improve things across the board. This field is notoriously slow to change. Requiring "no-flash" photos should be the first step because it starts to even the playing field. You yourself said that when clinics use flash it is deceptive so I'm sure you'll agree that this would be a logical first step. All it requires is pressing one button or moving a dial one click from "auto flash" to "no flash".

 

It is a common assumption by many people that using a flash is normal. Most cameras that people own, be they point & shoot or even on smartphones, are not set up for taking good photos in less than ideal lighting. Photos usually will turn out dark with strong shadows and "noise" which shows up as tiny speckles or "grainy". That is why the majority of patient taken photos look so bad. They are either taken in horrible lighting and the photos look fuzzy or they are blasted by the flash from their iPhone or whatever they are using and they look like a different person. Flash is necessary to make up for these shortcomings but they do so at a cost. They should only be used in social settings, not when one is trying to present a hairline that dozens of people will see every day of one's life.

 

Mickey, you once said that clinics using flash is deceptive when we were discussing this in another thread. You have a list of doctors you "advocate" in your signature but many of them use flash in their photos. Does this mean you are advocating deceptive clinics? I'm sure the answer is no and they probably don't realize what they're doing but maybe you could work with me to help change this. That is why I mentioned you and several others in my initial post; you guys have been around for a while so you are in a better position to help me out on this as opposed to someone that just joined the boards last week. What say you all? Will you step up and help me to set a new standard, a new requirement for clinics that no flash be used in photos? This is step one because after that we can continue to move the bar higher.

[Blake Bloxham]

Joe,

 

I think you bring up a good point. Standardizing photographic practices and ensuring accurate representation of hair transplant results is pivotal. Bill, in fact, created a thread with simple instructions for taking and presenting compelling and accurate photographs back in 2008: How to Take and Present Compelling and Realistic Photographs.

 

I see you shared your views about flash photography in this thread. This brings me to ask an important question: Can we, as moderators of the community, help institute better photography practices by updating this thread? Would including updates regarding today's photographic technology and practices perfected by cutting edge clinics like Hasson & Wong and Injerto Capilar (Lorenzo) encourage better practices? Would you, Joe, be willing to contribute to such a thread? If so, perhaps we can garner input from other practices sharing quality presentations and integrate this into the thread as well?

 

I would love to work on a project like this! I think our community is responsible for a number of quality practices and standards in the hair restoration field; I would be proud to add "setting the standards of photographic hair transplant results" to this list. Let me know what you think.

[Mickey85]

Hi Mickey85,

 

I agree but that is not an issue of laziness. When I first introduced the idea of HD video for documenting hair restoration results it was a huge undertaking. I had to learn about HD codecs for converting files and compressing them as much as possible without losing the quality of HD. It took forever to take the file off of a TAPE and learn how to convert it to something that could be edited. The file sizes were massive too. Roughly 8 years later it is much easier and cheaper BUT most clinics just don't know how to shoot a short video and edit it to make it presentable even on the most basic level.

 

I would love for video documentation to be a standard but baby steps should be taken to improve things across the board. This field is notoriously slow to change. Requiring "no-flash" photos should be the first step because it starts to even the playing field. You yourself said that when clinics use flash it is deceptive so I'm sure you'll agree that this would be a logical first step. All it requires is pressing one button or moving a dial one click from "auto flash" to "no flash".

 

It is a common assumption by many people that using a flash is normal. Most cameras that people own, be they point & shoot or even on smartphones, are not set up for taking good photos in less than ideal lighting. Photos usually will turn out dark with strong shadows and "noise" which shows up as tiny speckles or "grainy". That is why the majority of patient taken photos look so bad. They are either taken in horrible lighting and the photos look fuzzy or they are blasted by the flash from their iPhone or whatever they are using and they look like a different person. Flash is necessary to make up for these shortcomings but they do so at a cost. They should only be used in social settings, not when one is trying to present a hairline that dozens of people will see every day of one's life.

 

Mickey, you once said that clinics using flash is deceptive when we were discussing this in another thread. You have a list of doctors you "advocate" in your signature but many of them use flash in their photos. Does this mean you are advocating deceptive clinics? I'm sure the answer is no and they probably don't realize what they're doing but maybe you could work with me to help change this. That is why I mentioned you and several others in my initial post; you guys have been around for a while so you are in a better position to help me out on this as opposed to someone that just joined the boards last week. What say you all? Will you step up and help me to set a new standard, a new requirement for clinics that no flash be used in photos? This is step one because after that we can continue to move the bar higher.

 

I still stand by my statement that clinics that do use flash are using deceptive tactics, intentionally or not. I am aware that certain surgeons I advocate do happen to use flash in some/most of their shots. I advocate these surgeons because of their quality FUE work and choose to list it publicly because of the plethora of messages I get on the topic. I don't agree with everything they do and have expressed this publicly. Erdogan(or any surgeon) wetting the hair in the pre-operative photos is not right at all as it serves no functional purpose, but I do advocate him because he has great FUE results. Sadly I don't think there are many clinics out there which do not employ some sort of embellishment. Be it styling the hair in a very favorable way, favorable lighting and camera angles for photos(many clinics), flash, avoiding certain angles that make the result look unflattering(Diep) etc.

 

I do agree that getting clinics to stop using flash first is a paramount step and this grassroots movement is certainly positive and beneficial for perspective patients. I'm on board for sure. Let us know what else we can do, I don't think there would be many(if any) guys opposed to having more honest documentation Alot of the guys here are vocal about wet hair in the pre-operative shots which is encouraging but also much easier to detect than flash. We need a protocol that can accurately assess whether flash is being used because often it is not always so apparent.

Edited August 31, 2014 by Mickey85

[JoeTillman]

Would you, Joe, be willing to contribute to such a thread? If so, perhaps we can garner input from other practices sharing quality presentations and integrate this into the thread as well?

 

Blake,

 

Of course I'll contribute. I've already published information on this and there is a video I made on how patients can take photos when they submit to a clinic.

 

I still stand by my statement that clinics that do use flash are using deceptive tactics, intentionally or not. I am aware that certain surgeons I advocate do happen to use flash in some/most of their shots. I advocate these surgeons because of their quality FUE work and choose to list it publicly because of the plethora of messages I get on the topic. I don't agree with everything they do and have expressed this publicly. .

 

If the photos are not accurate, or even "deceptive" then how do you KNOW the work is as good as you say it is? Its like looking at a painting draped in a veil and saying how beautiful it is. You don't really know until the veil is removed. See my point? THAT is why I'm so passionate about this. Photos are shown, people say "ooh" and "ahhh" but they don't know what the result really looks like. What they think it looks like is a complete fabrication. This has nothing to do with any specific clinic, btw, just the issue in general.

 

I do agree that getting clinics to stop using flash first is a paramount step and this grassroots movement is certainly positive and beneficial for perspective patients. I'm on board for sure. Let us know what else we can do, I don't think there would be many(if any) guys opposed to having more honest documentation Alot of the guys here are vocal about wet hair in the pre-operative shots which is encouraging but also much easier to detect than flash. We need a protocol that can accurately assess whether flash is being used because often it is not always so apparent.

 

Good stuff. Agreed, the wet hair shots are more easily detected. I'll look into putting something together that can help people spot flash shots. I know what to look for but it may be difficult to quantify in text. Maybe a video? I may have to just show a bunch of examples. I'll think about this.

[Mickey85]

Blake,

 

 

 

 

If the photos are not accurate, or even "deceptive" then how do you KNOW the work is as good as you say it is? Its like looking at a painting draped in a veil and saying how beautiful it is. You don't really know until the veil is removed. See my point? THAT is why I'm so passionate about this. Photos are shown, people say "ooh" and "ahhh" but they don't know what the result really looks like. What they think it looks like is a complete fabrication. This has nothing to do with any specific clinic, btw, just the issue in general.

 

 

 

 

Because I do not simply rely on clinic-posted results Joe. I search the foreign forums and inspect the results and progress posted by patients themselves. I find patients to be much more honest about their outcome compared to clinics. Clinics often pick the best photos, the most favorable angles, the best lighting and the most favorable hairstyles. I'm always more skeptical of clinic photos. I don't think any clinic should use flash, favorable angles, tricky lighting, flattering hairstyles etc but I know this is asking for alot in this industry.

 

Please do put something together that can show us how to detect whether or not flash is used. That would be very beneficial to everyone.

[1978matt]

I think a good start would be to require every doctor to post at least 1 result per month, or maybe 10 year or something that would be considered reasonable.

 

I had a quick scan of the list of docs and can't remember EVER seeing a Dr Nusbaum result!

[Raj Jayukdht]

I think all the doctors that are recommended on this site should be told how to take photos/what angels/no flash etc and than post them on this site.

[Mickey85]

I think all the doctors that are recommended on this site should be told how to take photos/what angels/no flash etc and than post them on this site.

 

That would be the quickest and easiest way to eliminate embellished results. Have a strict protocol across the board. Even the playing field. If you want stay recommended(or be recommended) you must not use flash, no wetting hair in the pre-op(wet the hair all you want in the post-op though), have at least X amount of photos(none of this 1-2 photo deal like Bernstein, sorry), set angles etc. Just my opinion...

[KO]

We can only do these things if we have the support of the moderators who should be making requirements for posting. We are guests here, we cannot really urge the clinics to post one way or the other.

[Cant decide]

Every clinic recommended on here should be required to present at least monthly and a standard approach should be used I agree. I am always amazed at how many clinics post just a few details and then a few random pics. Why not take the time to put a nice standard presentation together?Personally, I like the way the Shapiro brothers do their documentation. Realistic consistent photos and a lot of patient/procedure detail in a standard way. Although they should throw in a video as well.

 

While I agree in photo and video accuracy, I think what some are advocating for is overkill. We don't need to see a million angles, wet post op results, parting the hair in a million places., etc This is essentially making your result look like worst case scenario which is unrealistic in the other direction as this is not how your hair is seen in most cases in every day life. Good solid video and pics should be posted that show the hair not in the most favorable way but also not in the harshest either. A happy medium is required IMO