lighting and exposure can give a result. No surgery has been performed on this patient.

Similarly, in Fig. 9.10 we can see a big improvement in periorbital wrinkles and lines which could be purported to be from botulinum toxin or even perhaps fractionated laser resurfacing. In fact, all that has happened here is the patient has relaxed or contracted their orbicularis or simply are smiling. Because the photo is closely cropped, an inexperienced eye will not detect the activation of the muscles involved. When assessing such treatments the photo should have a wider frame so that it can be clear that there is no fudging involved.

In reality, cosmetic treatments, be they surgical or nonsurgical, are very good these days and there is excellent training available in most continents. Photos do not need to be fudged. Results usually speak for themselves and if photos are accompanied by accurate captions and explanations then patients are more likely to harbor realistic expectations and not be misled.

9.8 Consent

In any medical endeavor, it is important to obtain informed consent from the patient. This also includes consent for the use of a photographic image. In my view, it is important to obtain specific consent for the use of photos. We all routinely use before and after photos as

Fig. 9.10 Before and after crows’ feet lines. Cosmetic photography, no treatment at all, just relaxation/activation of obicularis muscle. Close cropping of the photo might fool an inexperienced eye

part of the patient record. Many consent forms have a general statement to the extent that the patient “consents to the use of photographs for medical record purposes.” Such a statement does not extend to the use of photos for advertising or any other purpose. Sometimes the general statement might include “… use of photos for medical records or education purposes.” It is imperative to be more specific about the exact nature of the “education