I wanted to share thoughts on lighting in before and after photos. A common claim on this forum is that most doctors are using lighting tricks in their before and afters to deceive people into thinking their acne scar results are better than they actually are. I think many of the scar result photos that doctors post are honest or the lighting is unintentionally different but the result is still real, so it's sad to see posts with great results discredited because it can discourage people from seeking treatment from that doctor or using that technique.

I'm not saying that deceiving people with lighting tricks never happens, because I'm sure it does. I should also say I'm sure doctors pick their best pictures and may not show ones with bad results (I can't say for sure but I imagine they do), but that's not what this is about. I'm just saying: let's cut them a little more slack when it comes to lighting and here's why based on recent experiences on my scar journey  

Some things I've noticed after taking a lot of pictures and by having my picture taken in 3 different doctors offices in the US:

1) Your skin pigment changes with the seasons over time and with treatments. Laser will generally make you slightly redder for awhile. Pigment changes will make it appear that the lighting is different, even if it isn't

2) Acne scar experts probably aren't the ones taking the pictures. If they are popular, they probably have a busy office and use an assistant to take pictures. So you might have some pictures taken by Assistant 1 in Room A for the before picture, and the next time by Assistant 2 in Room B. This can make it hard to reproduce because the lighting can be very different, especially with windows

3) At the doctor, they probably don't have a fancy camera tripod locked at an exact reproducible angle with fancy lighting; it's probably someone holding an iphone with *maybe* a second iPhone flashlight. At two different doctors, I stood by the door and there were windows in the room - the lighting would change based on time of day and seasons if I came back months later.

4) Most importantly, it's very difficult to have an exact lighting match! Go ahead and try this at home: take a picture and reproduce the lighting from a picture 3 months ago. How many tries and how long did that take? Now imagine how much time they have at the doctor: it's about 30 seconds per picture - they usually have better things to do. I have taken MANY before and after pictures with my iPhone: same time of day, same room, same angles and it takes a lot of time and effort to reproduce it. 

5) If you have good improvement, it's actually harder to tell if the lighting is the same when taking your own before and afters! The reason is because you can't use your scars as a marker of comparison (in addition to the pigment changes)

6) The patient needs to consent sharing photos. Don't you think it would be weird to ask a patient who had no improvement if they can use their photo as an example before and after?

7) Unless there's an extreme lighting difference, there's not a MAJOR difference if the lighting is slightly different. It's not going to make a poor result look like an amazing result. 

The opinion I'd like to pass on is this: if a doctor consistently posts good results for acne scar treatments, ask yourself which scenario is more likely: a) the doctor treats a lot of acne scars and is good at treating acne scars or b) the doctor treats a lot of acne scars and is bad at treating acne scars, so instead of finding a better technique they train their assistants to take "bad" before pictures and "good" after pictures, and repeat this over and over, because they have no soul and only care about money. I hope after this, you'll consider that scenario A is more likely