I have posted before-and-afters since 2014. This is not a post against them. It is about how to read them.
Marc McKee of This Is My Journey is 126 pounds down on a GLP-1. He asked me what the photos hide. Here is the exchange, as I said it.
Marc: What do you most want people to understand about surgery that before-and-after culture online hides?
Me: I would stay away from anybody that has one or two or three amazing before and afters and that’s it. You want to see a surgeon that’s posting before and afters every day, and they’re all consistent, and they’re all getting good results. They’re not going to all be home runs, because it depends how the patient comes in. You can’t get a home run out of everybody, but you can definitely get them to a better place as long as the expectations are set.
Three photos is a portfolio. A daily feed is a track record.
Me: The before and after doesn’t tell the whole story. It doesn’t tell you about the patient’s psychology, if they’re happy or not. You don’t know that from a photo. Some patients get amazing results and they’re still not happy; they have these little things they want to perfect. It doesn’t tell you about the recovery, everything they had to go through, or any complications there could have been. And of course the cost the patient had to undergo, what it cost the family, just getting through the whole procedure. The before and after is a quick fast-forward through all of that. But it is an important part of choosing a surgeon, because you want to see somebody that can consistently deliver good results.
Psychology. Recovery. Complications. Cost. None of it is in the frame.
Marc: How do you handle it when someone wants something surgery can’t give?
Me: That’s the toughest part of my job, telling patients that’s not possible. Realistic expectations. We have to set that from the beginning, otherwise nobody’s going to be happy. I’m not going to be happy, the patient’s not going to be happy, it’s going to be a sad story. Thankfully, with social media and the way we’ve been educating patients, less behind the curtain, patients are having a lot more realistic expectations. Some patients bring wish photos and you have to coach them. You have to tell them, this patient you’re showing me is 20 years old, you’re 40. Or this patient’s BMI is 20 and you’re still at 30. You look much better than you did before, but we can’t compare apples to oranges.
Bring the wish photo anyway. We will talk about it.
Me: And realistic expectations afterwards too. Patients who have lost a lot of weight, we do these surgeries and we’re pulling as tight as we can, but the skin, because it’s lost that elastin, is going to give again. We lose some of the result over the first six months. Another realistic expectation is that a lot of times, six months later, we have to do a little nip and tuck to tighten things up and get them right.
That is the part nobody posts. The early after is pulled tight. The six-month after has settled. A small revision does not photograph.
Marc: What made a Mayo-trained plastic surgeon decide to show the public what happens in an operating room?
Me: Before, I would have a consultation with a patient in front of me and they were so anxious and worried, and I was giving them all this information, and I think it just went in one side and came out the other. At the end of the consultation they were more confused than before. Now they come in and they know what’s going on. They’re telling me what they want. I start explaining and they’re like, yeah, yeah, I know, I know. It’s a lot more comfortable, and I think they are better for it.
Marc: What does #StayBeautiful mean and why is it significant to you?
Me: This is one of the slogans we came up with early on. Everybody’s beautiful when they come in. We’re helping you become the best version of yourself, and we’re working as a team to get there, but it doesn’t mean that if you don’t have plastic surgery you’re not beautiful. There are certain things that make each person beautiful, and it’s not always the physical. The other slogan we say a lot is happy is beautiful. If you’re happy, you’re beautiful.
So read the feed all the way down. Your age. Your BMI. Their ordinary result, not their best one. Then remember the after is month one of a six-month story.
The five-minute license and board check comes before any of this. The rest of what I said on the podcast, on loose skin and timing, is here.
Call (915) 590-7900, text 1-866-814-0038, or book at agulloplasticsurgery.com. #StayBeautiful
Find me at @RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.