ANYONE planning to go under the knife to improve their looks should heed a warning from the nation's leading plastic surgeons: the camera does lie.

The British Association of Aesthetic Plastic Surgeons (BAAPS) claims rogue practitioners are cleverly manipulating "before and after" photographs to make their work appear far more effective than it is.

Genuine patients are frequently photographed in the least flattering way before and the most flattering afterwards, wildly distorting the true effect of the procedure.

Attended by more than 300 plastic surgeons on Friday at the Royal College of Surgeons in London, the conference was shown how even simple changes in the lighting of a photograph can dramatically mislead patients about what to expect.

Charles Nduka, a plastic surgeon at St Mary's Hospital, London, said digital picture manipulation software had made it easier than ever for surgeons to boost business by altering photographs.

"One could rightly claim that these images are not re-touched," said Nduka. "But changes in lighting and positioning of the subject can produce impressive results.

"Undoubtedly photography is a vital tool for the plastic surgeon, but with the advent of digital photography and desktop publishing software it is very easy, even for the novice, to manipulate images.

"This is important both in marketing material from commercial companies and in research publications describing novel techniques where the issue of research misconduct has been an important topic recently.

Norman Waterhouse, a consultant plastic surgeon with a practice in London's Harley Street, said: "Magazines seem to be full of before and after pictures showing the apparent benefits of cosmetic treatments.

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

Plastic surgery has surged in popularity in recent years, with 16,367 operations being carried out by BAAPS members in their private practices in 2004. In 2005 they experienced a 34% rise.

Surgeons claim the rise in the number of people going under the knife has been fuelled by the growing acceptance of cosmetic surgery and the increasing number of celebrities openly admitting they have had a nip and tuck.

But they also fear that overuse of manipulated images in magazines and in marketing material will lure patients into having surgery with unrealistic expectations of what cosmetic surgery can do for them.

In one infamous example, the British actress Kate Winslett was heavily airbrushed for an appearance in the men's magazine GQ. She was furious that the magazine had retouched her pictures to make her look slimmer. "I do not look like that and more importantly I don't desire to look like that," she said afterwards.

They set out standardised procedures for lighting a subject and how to position a model for an accurate image. They also state the correct method of handling digital images and set out what photographs should be used for.

Adam Searle, president of the association, said photographs were a valuable tool for documenting new cosmetic procedures, aiding patient consultations and for marketing.

He said: "We promote the highest ethical standards in aesthetic practice, including the use of modern photography techniques. They can be a powerful tool for documentation and research purposes, and must be used responsibly."

A spokeswoman for patient counselling website Cosmetic Support said: "We are often contacted by people who have seen photographs in adverts in the back of magazines or are shown them by a surgeon, but when they have the surgery themselves are disappointed with the results.

"Patients need to take a step back and ask a surgeon realistically what they can do for them. They have to remember that advertisers don't use photos from a realistic angle, but the best angle."

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