The photographic treatments create questions. Why use a black background? A sky blue background is recommended.5 Why shade the control side (a practice that does not belong in a scientific publication)? Why is there a black margin running down the middle of the illustrations? Should the photographs not be continuous? Why not simply present two standardized photographs side-by-side that are not digitally edited? Photographs featured on an investigator’s Web site6 that also appear on the manufacturer’s Web site7 reveal that the background has been changed from blue to black. The funding statement3 discloses that the manufacturer provided photographic services. Such outsourcing is highly unusual in scientific studies and invites photographic manipulations, both known (e.g., background color change) and unknown. A company that has invested heavily on research and development of its product, including fees paid to investigators,8 should not be entrusted with photographs, which are of essential importance in treatment evaluation.
The manufacturer, Zeltiq Aesthetics (Pleasanton, Calif.), provided equipment and consumables, and compensated both patients and the study site for treatment and follow-up visits.3 Unfortunately, once investigators accept reimbursement, whether directly or indirectly, objectivity is lost.1,2,8 It is becoming increasingly clear that plastic surgeons may function as highly-paid consultants or objective researchers, but not both.1,2 The reader looks to our professional journals for unbiased scientific articles on which to base important decisions regarding treatment recommendations and expensive equipment acquisitions. We need to be diligent to protect the integrity of the scientific process and ensure that our journal publications do not become simply marketing tools.2 It is not clear that the cost-to-benefit ratio favors a method that reduces the fat thickness 1/10 inch in 16 weeks. Patients and surgeons need to be properly informed. Photographic integrity is vital to this process.
The author has no conflicts of interest to disclose. There was no outside funding for this study.
Eric Swanson, M.D.
Leawood, Kan. 66211
1. Lopez J, Prifogle E, Nyame TT, Milton J, May JW Jr.. The impact of conflicts of interest in plastic surgery: An analysis of acellular dermal matrix, implant-based breast reconstruction. Plast Reconstr Surg. 2014;133:1328–1334
2. Luce EA.. Financial conflicts of interest in plastic surgery: Background, potential for bias, disclosure, and transparency. Plast Reconstr Surg. 2015;135:1149–1155
3. Stevens WG, Bachelor EP.. Cryolipolysis conformable-surface applicator for nonsurgical fat reduction in lateral thighs. Aesthet Surg J. 2015;35:66–71
4. Swanson E.. Photographic measurements in 301 cases of liposuction and abdominoplasty reveal fat reduction without redistribution. Plast Reconstr Surg. 2012;130:311e–322e discussion 323e–324e
5. DiBernardo BE, Adams RL, Krause J, Fiorillo MA, Gheradini G.. Photographic standards in plastic surgery. Plast Reconstr Surg. 1998;102:559–568
8. Swanson E.. Cryolipolysis: The importance of scientific evaluation of a new technique. Aesthet Surg J. 2015;35:NP116–NP119
9. Garibyan L, Sipprell WH III, Jalian HR, Sakamoto FH, Avram M, Anderson RR.. Three-dimensional volumetric quantification of fat loss following cryolipolysis. Lasers Surg Med. 2014;46:75–80
10. Coleman SR, Sachdeva K, Egbert BM, Preciado J, Allison J.. Clinical efficacy of noninvasive cryolipolysis and its effects on peripheral nerves. Aesthetic Plast Surg. 2009;33:482–488
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