Don't Get Poached

Imagine a woman researching an aesthetic procedure. She goes online. She likes what she sees in a doctor's before-and-after gallery and determines that the provider who posted them does great work.

There's just one problem, and it's a big one

The images in question aren't examples of that doctor's work. They're examples of someone else's—yours, perhaps—copied off the Internet and used to deceive prospective patients. It's called photo-poaching, and you could be losing business because of it.

“I've caught 20 to 25 medical practices using my photos on their websites,” says Seattle-based facial plastic surgeon William Portuese, MD. “Right click, cut, and paste, boom! It's that easy.” If something is on the Internet, it can almost certainly be copied and pasted, i.e. poached. It happens with all sorts of content, but it takes on added significance in a discipline where people rely on images to make major decisions about their health and wellbeing.

In fact, before-and-after images are among the most important factors in the path to purchase. In a RealSelf survey of 1,039 consumers considering cosmetic surgery, 69 percent said they need to see 11 or more sets of photos to confidently pick a procedure. The number climbs to 77 percent if they're using photos to choose a doctor.¹ Of those, a significant number want to see not 11, not 12, but at least 30 sets of photos, with 29 percent saying they want 30+ before and afters when choosing a procedure and 26 percent wanting to see 30+ sets when choosing a doctor.

Clearly, a comprehensive gallery of before and afters is a good thing—people like to see a diverse range of both patients and outcomes—but size alone is no guarantee of trustworthiness. In a survey of 700 men and women who had requested a consultation with a doctor on RealSelf, the overwhelming majority said that while a doctor's before-and-after photos are important for research, just 27 percent described patient photos posted by doctors as “very trusted.”²

Poaching makes that trust even harder to come by, as duplicate images are doubly troublesome: They not only sow seeds of doubt in the minds of potential patients, but can also put them at risk if they make medical decisions as a result. It's essentially deceptive advertising and, if left unchecked, can even cast aesthetic medicine in a poor light. It is imperative that doctors find out if their own before and afters are being used inappropriately and confront the offenders.

Setting the Trap

There are several ways you can track down unauthorized copies and uses of your photos. The simplest is to use a reverse image search, which as the name suggests, entails searching not by typing in words but by uploading an image and letting software look for duplicates. Google and Bing both offer reverse image search. Services, such as TinEye.com and ImageWitness.com, combine free image searches with ongoing automated tracking/reporting for a fee.

When searching a large array of photos, pattern-recognition technology provides another way of discovering stolen/duplicate photos. In fact, this is the number one way we find out about the use of stock photos on RealSelf, as consumers will sometimes see a photo in both a doctor's gallery and on a brand site. More often than not, their completely reasonable assumption is to think, “Wait, if this photo isn't of the doctor's actual work, what about the others?” When we discover such images, we take swift action to have them removed from RealSelf.

We've also found that, in many cases, doctors are unaware that they're using another doctor's images or stock photos, because their staff didn't understand the importance of using only authorized photos. It's important to have a photo policy in place to ensure your marketing staff is on the same page regarding what images they can use and which ones they can't, with those that do not represent your work at the top of the list.

Of course, if someone else is using images of your work to market their services, that's another matter entirely. If that's the case, it's time to take action.

Protecting Your Assets

You can't stop people from copying your images but you can make it unpleasant for them. You can, for example, use software, such as Digimarc or SignMyImage, to embed each image with a snippet of tracking code, aka an “invisible watermark.” Neither will prevent unauthorized copying but they can help you build a stronger case for ownership once you track them down.

Copyrighting offers another path to protecting your images. By producing the photo (and, of course, getting appropriate consent), you automatically own the copyright to it. However, if you want to actually enforce that copyright, you have to register it with the Library of Congress, which entitles you to pursue legal action, including statutory damages and attorney's fees if you're successful.

Unfortunately, relying on copyright comes with its own challenges, including the requirement to prove the infringement harmed your business (“damages”) and the difficulty of pursuing relief and remuneration in an increasingly global market. “It's a big problem internationally,” says Dr. Portuese. “Copyright doesn't matter; intellectual property doesn't matter. I found a doctor in China who actually wrote his name across my patient's face.” Closer to home, however, Dr. Portuese had success getting unauthorized images removed and compensation paid.

Another option is to send a takedown request to the Internet service provider (ISP) that hosts the poacher's website. Unlike reviews, which are protected speech (as long as they're not defamatory), poached photos indicate copyright infringement—and no ISP worth its license wants to be a party to that. “It can be pretty powerful,” says Eric Goldman, professor of law at Santa Clara University School of Law. “Whoever gets that notice probably doesn't have any investment in the matter; they just want to minimize their liability.”

The Bigger Issue

Even if your photos have never shown up on someone else's website, poaching can still take a toll on your practice. Issues of false advertising and copy infringement aside, patients who come across the same image on multiple websites are bound to have doubts.

Consider the case of Angelina*, who, while considering Cellulaze, received a before-and-after photo from a doctor she was considering. A researcher by training, she then went online where, much to her surprise and dismay, she found the same set of photos on other doctors' websites. “I was appalled. They all claimed or implied that it was their work,” she says. “It just really makes me hesitant as a consumer to see things like that.”

No doubt other aesthetic consumers have had similar experiences, which, over time, could undermine trust in the entire industry. For Mr. Goldman, it's not unlike those miracle weight-loss images, in which newly skinny people pose with their XXX-Large pants held out in front of them. Such photos not only portray unrealistic results but strain credibility in the process.

For aesthetic professionals, poached photos could have a similar impact, sowing doubt, damaging reputations and giving unethical providers an unfair competitive advantage. Unfortunately, as long as there's an Internet, photos will be used without permission, underscoring both the challenge and the need to actively address it. As Mr. Goldman says, “It's a good opportunity for the industry to take stock of the problem and figure out how to signal to consumers that they can trust the information that's being provided.”

1. RealSelf data.  https://trends.realself.com/2016/02/10/how-many-before-after-photos/

2. RealSelf data. https://trends.realself.com/2015/07/02/before-after-photos-trust-survey/

* Name changed at patient's request