#TheUglyTruth? A Qualitative Evaluation of Outcomes Photography on Instagram: Introducing the SEPIA Scoring System

Photographs of cosmetic treatment outcomes on social media are prone to bias and misrepresentation from nonadherence to established photographic standards. However, there is currently insufficient information regarding which norms are most-commonly violated, precluding quality improvement efforts. METHODS: A qualitative study of cosmetic treatment photographs published on Instagram was undertaken in accordance with the Guidelines for Reporting Reliability and Agreement Studies using a newly proposed Standards for the Evaluation of Photographs In Aesthetics (SEPIA) nine-point photograph scoring system and grading scale. RESULTS: A total of 510 posts encompassing 2020 clinical photographs published by 102 practitioner accounts on Instagram were audited for photographic quality. The average score was 4 out of 9 (medium quality), with approximately 40% of posts scoring in the low-quality range. Zoom, lighting, timing, and presentation of multiple views were the standards most-commonly disregarded. Plastic and Reconstructive Surgery specialty and subspecialty (PRSS) practitioners scored higher (4.5/9 versus 3.1/9, P = 0.002) and had fewer low-quality posts (22% versus 54%, P = 0.001) than non-PRSS providers. Low-quality photographs were most often seen with rhinoplasty (30% versus 7%, P < 0.00001) and lip filler (60% versus 33%, P = 0.0001) compared with surgical and nonsurgical treatments, respectively, due to a higher incidence of immediate photographs and selfies. CONCLUSIONS: Before and after photographs of surgical and nonsurgical cosmetic treatment outcomes on social media are frequently of substandard quality. This study outlines specific items frequently neglected in outcomes photography to assist practitioners in maximizing adherence to established standards of photography online.