As an hobbyist photographer (you know, the hobby my real job pays for) I have studied a lot about certain aspects on how to make a person look good when taking a picture (I'm not talking about photoshop, yet).2 Every minute detail starting from lighting to posing, angles, backgrounds, clothing, attitude, and even that stray hair on the shoulder go into creating a flattering photograph of someone. Ignoring these details typically leaves the photographer with a bad picture and an unhappy client.
Many of the fad health products now sold on T.V. feature the classic "before and after" picture to try and "prove" that their product works. My favorite commercials are for the weight loss supplements. On the popular social media site Facebook I have seen many people praising a body wrap product knows as "It Works Body Wrap".3 This product is being touted as a diet-free, exercise-free way of taking inches off those unsightly parts of your body (I haven't seen where it claims to be a weight loss product, yet). On Facebook, there are hundreds of before and after pictures online that people are posting as "proof" this product works. I would like to use the following as an example and also show you why before and after pictures are not evidence as used in the scientific community.4 Please note that many people, especially women, all very familiar with these techniques and perform them quite easily without much guidance.
1. Hand on hip: This is a very common pose for women to slim the waste line. In essence, by putting your hand on your hip you're pushing your hip away from the camera. Notice her shirt and the creases formed by her pushing in on her hip.
2. Tight clothing: Tight clothing always makes someone look thinner (unless that excess body fat is bulging out from under the tight clothing, Chad). Notice in this picture the woman rolled the front of her shorts in up thus elevating the front hem and pulling the back tight. Not only did that tighten her shorts making her gluteal appear thinner but it also created a diagonal line in her shorts which is more slimming compared to the horizontal line shown in the before picture. One would think that if she were to really lose inches then wouldn't those shorts be more baggy instead of tight?
3. Weight shifting: In the after picture we see more of the back calf than the before picture because the subject here is shifting her weight to her away from the camera side, again another technique we typically use in conjunction with hand on the hip, thus slimming the appearance of the hip.
4. Leg position: When the subject shifts their weight onto the back leg the front leg is free to position for maximum slimming effect. The best way is to have the leg at a slight angle thus reducing the appearance of the overall girth. Notice in the after picture the knee is slickly angled toward camera.
5. Distance: Notice that the distance from the camera has also increased from the first picture to the second. In the second we see some of the subjects feet while in the first she is completely cut off above the ankle. The farther one is from the camera the easier it is to slim down.
6. Timing: While this isn't labeled on the picture I'm pretty sure this image was taken on the exact same day, just minutes apart. The first reason is that it looks like she is standing on the exact same tiles in both pictures, not something most people would remember to do after they used a product. Second is that the shadows fall on the same part of her gluteals, calves, thighs and different objects in the room. This looks like daylight and so you would think that with the passage of time you would have differences in shadows. Now if it is artificial lighting then she would have had to stand pretty much in the same position as the before picture, one thing I don't think many people would take into consideration. This point is more speculation on my part.
We're used to the phrase, "a picture is worth a thousand words," but in today's age we might want to change it to, "a picture is worth a thousand lies, and dollars." Appealing to the visual senses is the most powerful part of advertising and so we see multiple techniques on how to manipulate the "truth". In today's age we cannot use pictures as evidence that a product works. Such products should be backed up by objective, reproducible studies without bias. Anecdotal evidence is also not enough to validate a product.
Tyler d'Hulst, PA-C, MPAS
 Before and after shots are not the only use of photographs to "prove" a product works. Pictures are, “...35 degrees out of 360 degrees and call it a photo," - Joel Sternfeld.
 Photoshop is a very powerful image editing tool that can pretty much turn anyone into a super model. Not many people have Photoshop and among those that do, not many are proficient enough with it to make significant changes. The techniques I mention about above are very simple and common techniques all people can use to appear more slim without the use of the liquify brush in Photoshop.
 I'm hoping Chad will do a post about this specific product. I just don't have the time to research it like those of us who sit in front of a laser all day long.
 The use of photography as evidence is highly criticized among many fields as it is so easy to manipulate a digital image (and surprisingly manipulating film images was very common and somewhat easy). Today, unless an image is saved as a RAW format then it cannot be considered the original image and thus one has to assume it has been manipulated. Formats such as JPEG, TIFF, PSD, BMP, GIFF are all computer formats but a RAW image is straight from the camera without any digital manipulation (not even by the camera).