Open Instagram on any given morning and you will find hundreds of plastic surgeons posting side-by-side images of their patients. Unflattering, poorly lit “befores” sit next to polished, perfectly lit “afters.” The implicit message is always the same: “look what I can do for you!”. As a surgeon who operates at the intersection of reconstructive and aesthetic surgery, I find myself thinking carefully about this phenomenon, not because I am above it, but precisely because I am not immune to its temptations.
The question I want to address honestly is this: what are the ethical obligations of surgeons when it comes to using patients to attract new patients, and what should prospective patients understand before they take any of it at face value?
Consent is more complicated than a signature
Every reputable surgeon will tell you that patients sign consent forms permitting the use of their images. This is true. But informed consent for surgery and informed consent for social media are not the same thing. A patient lying on a pre-operative assessment couch, nervous about their upcoming procedure, is not in the clearest position to weigh the implications of their photographs appearing on a public platform with a hundred thousand followers. Consent obtained in that context deserves scrutiny.
Genuine ethical practice demands more. It means explaining clearly where images will appear, how long they will remain online, whether they can be removed on request, and whether they will be used in paid advertising. It means revisiting consent if the context changes. And it means accepting, without complaint, when a patient simply says no.
What you may not be seeing
Even where consent is unimpeachable, what social media shows you is, by definition, highly curated. The before-and-after images a surgeon posts are their best work, taken on their best days, on their most photogenic patients, under controlled (and all too often different) lighting conditions. The cases that did not go to plan, the revision surgeries, the prolonged recoveries, the patients who were simply unhappy, do not make the grid.
This is not necessarily dishonest, but it is not complete. Photography itself introduces distortions: camera angle, focal length, lighting, and posture can dramatically alter the apparent result of a facelift, rhinoplasty, or any other procedure. Filters, even subtle ones, compound this. A patient making a decision about surgery based primarily on social media imagery is working with systematically incomplete information.
There is also the question of timing. Early post-operative results, photographed at six weeks when swelling has partially resolved but final healing is months away, can appear spectacular, and then soften, relax, or change as the tissues mature. This is particularly true of facelift surgery, where the final result continues to evolve for the better part of a year. An honest surgeon photographs results at twelve months minimum.
The patient as marketing asset
There is a more uncomfortable question lurking beneath all of this. When a surgeon posts a patient’s images, who benefits? The patient gains nothing: their privacy is reduced, their body is made public, and they receive no compensation. The surgeon gains followers, credibility, and, ultimately, income. This asymmetry is worth contemplating. It does not make the practice wrong, but it should make surgeons thoughtful about how enthusiastically they pursue it and how genuinely voluntary the consent they obtain really is.
How surgeons of integrity rise above the noise
The answer is not to abandon transparency, quite the opposite. The surgeons I most respect are those who show their work honestly: realistic timelines, a range of patients rather than only the most dramatic transformations, and a willingness to discuss complications and limitations openly. Education, not spectacle, is the currency of genuine expertise.
For my own part, I prefer to use social media to inform: to explain what a deep plane facelift actually does and why, to describe the anatomy underlying a rhinoplasty, to discuss facelift recovery honestly and in detail. The best patients, the ones who make the best surgical candidates, are the ones who arrive having done their homework, with calibrated expectations and genuine understanding of what surgery can and cannot achieve. That outcome is not served by an endless scroll of idealised results.
What patients should do
Before placing significant weight on a surgeon’s social media portfolio, ask yourself whether the cases shown reflect a range of patients or a carefully selected subset. Ask whether lighting and photography conditions appear consistent or optimised. Ask whether results are shown at early or mature time points, particularly important for facelift patients, where premature photographs are especially misleading. Ask, when you meet the surgeon, to see images from cases similar to yours, including cases where the result was good but not exceptional. Even ask to see their worst result!
Most importantly, choose your surgeon on the basis of their qualifications, their professional standing, their communication, and your confidence in their judgement. Social media is a window into a surgeon’s world, but it is a window they have dressed themselves. What lies behind it is what matters.