He did not manipulate the shots, but by changing the lighting used and shooting the model lying down, he managed to create the impression that her wrinkles had disappeared.

Worried that a widespread abuse of manipulated images in the media is harming patient trust, the British Association of Aesthetic Plastic Surgeons (BAAPS) is taking action and is holding its first photography course for plastic surgeons.

The one-day course, to be held later this month, will offer advice on data-protection issues, and explore advances in digital imaging as well as teach surgeons how to improve the accuracy of their before-and-after photographs.

"Surprisingly, there is currently no code of conduct in the use of photographs by plastic surgeons during pre-operative counselling and marketing.

Half a century ago the father of British plastic surgery Sir Harold Gillies said: "The advances in plastic surgery in the past 10 years are primarily those of photography."

He said photography was used for documentation purposes in the before-and-after shots, to aid patient consultations, and to show new techniques as well as for advertising and marketing.

However, despite its importance in the specialty, medics had never before received any formal teaching in photographic techniques, the medico-legal issues surrounding them or the impact of photo-manipulation.

Plastic surgeon and lecturer Charles Nduka, who is based at Imperial College and St Mary's Hospital in London, explained that advances in technology had made it much easier to manipulate the images.

"The main uses can be considered under the categories of documentation as part of the medical record, evaluation of the benefits or otherwise of interventions, and as an aid to doctor-patient communication.

Nicolas Miedzianowski-Sinclair, whose company Surface Imaging International provides 3D and 2D images, said its images showed people as they are, but said it would be easy for photographers to manipulate an image.

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