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Is Seeing Really Believing? The Impact Of Deceptive Photography On Acne Product Advertising

If you have searched the Internet for new acne cures, chances are you have come across some really bold product claims. “Cure your acne in 3 days!” one site practically shouts at you. “Cure your acne in 24 hours!” the next site promises. “Get rid of zits for good in just 2 minutes” yet another acne miracle product vendor claims.

And the sites come with before and after photos that really do look like the same person (of course, we don’t really know but that the model had clear skin before using the product and got acne afterward) and that really do make it look like the product works. But is seeing really believing?

Before and After Acne Image
Photographs are not good evidence of how well a procedure works, because photos can be altered to make appearances look better.

The simple fact is that photography usually is not good evidence of how well a procedure works. Acne treatments that really work usually work over a period of weeks or months1, up to about a year. While you are getting these treatments, you will probably be able to see a difference. Your friends will be able to see a difference. Your doctor and your doctor’s staff will be able to see a difference. The camera, however, won’t pick up a difference without using some techniques that also work if you aren’t getting any kind of treatment at all.

Setting Expectations

The more painful or expensive the procedure, the higher the expectations. The kind of treatment you use has a lot to do with the level of attention you pay to the details of your complexion. Chances are, before visiting the dermatologist, you will have already tried over-the-counter treatments2 that are more accessible and less costly.

Let’s suppose you bought a microdermabrasion cloth for US $9.99 and started using it on a regular basis. It doesn’t hurt to use the polyethylene cloth. It doesn’t make any dramatic changes, either. But if you look closely in the mirror, you may notice tiny changes in acne scars or brown spots of fine lines that justify your $9.99 purchase.

The situation is very different if you have just plunked down US $9999.99 for a series of surgical treatments to cut out acne scars. You will probably start looking for improvement before you even report for your procedure! The more you have invested in a procedure, the larger the changes in your appearance have to be before you notice them.

Doctors know this. Honest doctors try to talk to their patients so that they have a clear understanding of what to expect3. Add to this the reality that many good dermatologists are lousy photographers, which in this situation is a good thing, and expectations are lowered so that patients start looking for smaller changes. But dishonest doctors sometimes try to talk patients into paying for a procedure with deceptive photography that leads to upset later.

Improvement In A Flash

The most obvious way to alter appearance is to change the lighting. Many times all that is needed to make a product look like a wonder drug is to take the “before” picture in normal room light and the “after” picture with flash.

Anything that is three-dimensional looks worse in low light and better in bright light. Pimples, acne scars, and rough skin all seem to disappear in bright light. It’s not at all unusual for unscrupulous practitioners to ignore ethical photographic standards4. They take before and after photos at the same time, just with different lighting. But there is a way to conceal the deception even further.

Inconsistent Backgrounds

Photographers who want you to know precisely how much difference an acne product makes in your appearance take before and after photos with the same background. People who want to make an acne product appear to be more useful than it is usually change the background of photo or change the size of the head shot.

For instance, a before photo might be taken in low light against a black drape. The after photo might be taken the very same day, but there is a tropical beach in the background. Before and after photos you can really believe have to use the same subject in front of the same background for you to make a reliable assessment5 of the value of the technique.

Inconsistent Framing

Another common scam is inconsistent framing of the subject. Suppose a model has acne but a great body. In the first photo he or she is fully clothed, his or her blemished face occupying most of the photographic field. In the second photo, he or she is wearing a bikini on a that tropical beach and you don’t notice the acne-scarred complexion. The photo isn’t faked, but it isn’t honest, either.

Inconsistent Position

Yet another before and after acne photo scam is positioning the patient with chin pointed down toward the floor in the first photo and chin pointed up toward the ceiling in the second photo. This most commonly used when the model has brown or black skin. In the first photo, loose folds of skin where blackheads accumulate are more visible, and in the second photo, these folds of skin tighten and make any blemishes look smaller.

Changes In Aspect Ratio

Even doctors at medical conferences sometimes change the size of the patient’s image within the photograph frame (although probably not intentionally). If the patient looks smaller in the “after” photo, it’s harder to notice blemishes.


And, of course, countless advertisers manipulate images with the help of Adobe photoshop. If you are just looking at a thumbnail image you might not be able to pick out photoshopped images with the naked eye. Just look closely before you take the next big step6, such as committing to an expensive medical procedure or buying an expensive acne product.

There is one really good rule of thumb for detecting real versus fake images. Vendors who don’t offer money-back satisfaction guarantees often bolster their claims with fake images. Vendors like Exposed Skin Care who offer one-year no-questions-asked money-back guarantees don’t have any reason to use anything but honest images in their advertising.


  1. Tan A.U., Schlosser B.J., Paller A.S. A review of diagnosis and treatment of acne in adult female patients. International Journal of Women’s Dermatology. 2017;4(2):56-71.
  2. Kraft J., Freiman A. Management of acne. Canadian Medical Association Journal. 2011;183(7):E430-5.
  3. Main C.J., Buchbinder R., Porcheret M., Foster N. Addressing patient beliefs and expectations in the consultation. Best Practice and Research—Clinical Rheumatology. 2010;24(2):219-25.
  4. Cook C.H., Centner R.L., Michaels S.E. An acne grading method using photographic standards. Archives of Dermatology. 1979;115(5):571-5.
  5. Chiang A., Hafeez F., Maibach H.I. Skin lesion metrics: role of photography in acne. The Journal of Dermatological Treatment. 2014;25(2):100-5.
  6. Ashique K.T., Kaliyadan F., Aurangabadkar S.J. Clinical photography in dermatology using smartphones: An overview. Indian Dermatology Online Journal. 2015;6(3):158-63.
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