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Preliminary Results of the Before/After Pictures Survey


During the HONcode Certification and re-examination processes, the Health On the Net Foundation (HON) has been come across with websites posting before/after pictures[1], mainly relating to cosmetic surgery. HON has noticed that the publication of before/after pictures poses difficulties, since they can create false expectations among website users, and HON cannot guarantee that these pictures have not been modified, i.e. HON is not able to verify the authenticity of these pictures. However, at the same time, these pictures also are a tool for illustrating medical information and for demonstrating the quality of work done by a physician. Thus, the question arose how to treat websites publishing before/after pictures. Therefore, HON decided to launch a survey to find out what is the public opinion about displaying before/after pictures on websites.


The survey was conducted by the Health On the Net Foundation and contained the following closed questions:

  1. Are you a health professional or a non-health professional?
  2. Are you an editor of a medical/health website dedicated to plastic/aesthetic surgery or not?
  3. If you find before/after pictures on a medical/health website
    1. You find this useful?
    2. It does not bother you?
    3. You find this suspicious?
    4. It bothers you?
  4. HONcode certified website
    1. Should not display these before/after pictures?
    2. Should be able to display before/after pictures?
  5. Is this questionnaire understandable or not?

Furthermore, the respondents were able to provide their contact information as well as comments regarding the survey. The survey was both in French and English and was placed on the HON website and alongside the certificates of the HONcode Certified websites from mid-June until the end of September, 2011. HON received in total 1,365 responses.


The purpose of the survey was to understand the opinion of the health professionals and the non-health professionals with regard to the regulation of publication of before/after pictures.

Main Findings:

  1. 1,365 responses were received. 29.5% of the responses came from health professionals and 5.9% from respondents who reported to be webmasters of cosmetic surgery websites.
  2. 25% of the respondents considered before/after pictures on websites useful, while 45.3% considered the pictures to be suspicious.
  3. 68.8% of the respondents found that HONcode Certified websites should be able to display before/after pictures, while 30.2% considered that HONcode Certified websites should not display before/after pictures.

Preliminary Conclusions:

The majority of the respondents considered the publication of before/after pictures on websites suspicious. At the same time, the majority of the respondents also found that the websites should be able to display these pictures. This means that in order to reduce the suspiciousness of before/after pictures, actions should be taken, but that no significant need exists among website users to have the publication of these pictures prohibited. Therefore, HON is currently in the process of developing a guideline regarding the publication of before/after pictures, taking also into account the valuable comments given by the respondents of this survey.

The preliminary results in more detail:

[1] Within the scope of the HONcode Certification, the Health On the Net Foundation defines before/after pictures as images taken both before and after a medical procedure, including dental and plastic surgery procedures.


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