Before and After Facelift Photos on Social Media Reflect Misleading Pre- and Post-Operative Deviations

CLINICAL QUESTION

What are the image quality and discrepancy issues of social media-posted before and after photosets of patients who have undergone facelift surgery?

Bottom Line

There are significant inconsistencies in surgeon-posted before and after facelift photos found on Instagram concerning size, rotation, brightness, and more.

Background: The increasing popularity of facelift surgery can be partially attributed to social media. Instagram, for example, has billions of users and photo-sharing capabilities that offer surgeons increased visibility. Studies show that exposure to before and after photos increases the likelihood of considering surgery, but concerns remain over misleading and over-idealized content.

Study design: Cross-sectional study

Setting: Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head and Neck Surgery, Emory University School of Medicine, Atlanta

Synopsis: Using the tag #faceliftbeforeandafter, researchers mined Instagram for posts featuring side-by-side, pre- and post-operative facelift surgery images (n=~30,000). Of the 650 most popular posts, 567 met inclusion criteria, and 85.7% of these were posted by surgeons based in the U.S. Data on image backgrounds, makeup differences, geographic regions, and time since surgery were recorded. Using software for image analysis, researchers were able to objectively compare face size, rotation, and brightness between pre- and post-operative photos. Among the analyzed posts, 66.3% featured smaller post-operative faces, and 73.7% of post-operative photos displayed upward facial rotation. Brightness increases >10% were noted in 36.9% of post-operative posts. Inconsistent image backgrounds and makeup differences were present in 22.5% of photosets. Authors note that such deviations contribute to an aggrandized perception of surgical improvement and may set unrealistic expectations for patients. They state that established photography standards in facial plastic surgery could mitigate this effect, that it is the surgeon’s responsibility to ethically convey their practices online, and that educating patients about the limitations of social media may help align expectations with achievable outcomes. Study limitations included its cross-sectional design.

Citation: Mehta MP, et al. Facelift photo quality of social media: prevalence of potentially misleading before-and-after images [published online ahead of print May 12, 2025]. Facial Plast Surg Aesthet Med. doi:10.1089/fpsam.2025.0043.

Comment: This article is important because it shows how many surgeons are exaggerating facelift results in Instagram posts by using inconsistent head position, size, and lighting. Unfortunately, our subspecialty’s board is not monitoring these practices and does not have the bandwidth to do so, and so it is up to surgeons to make sure they are accurately portraying results on social media. Matthew Q. Miller, MD.