Photoshop as a management modality

On Twitter, @DrVanDamme pointed me to a paper in published in July 2019 in the International Journal of Oral and Maxillofacial Surgery, a journal of the International Association of Oral and Maxillofacial Surgeons (IAOMS).

The paper’s title is: Management of seborrhoeic keratosis and actinic keratosis with an erbium:YAG laser—experience with 547 patients, doi: 10.1016/j.ijom.2018.08.008, by A. Sayan et al.

In the paper, the authors, affiliated with Poole Hospital NHS Foundation Trust and Southampton General Hospital, Southampton (UK), describe a very effective laser treatment to remove certain types of skin lesions called keratoses.

Figure 1 shows how well the treatment works. In panel a), you see the patient before treatment, with multiple keratoses on the left cheek, next to the nose, and under the eyebrow. In panel b), the same patient is shown 6 months after treatment with the magic laser.

Copyright: Int. J. Oral Maxillofac. Surg. 2018; Patient gave consent.

If you look closely, however, these two photos are remarkably similar. Look at that one dark hair in the eyebrow, the position of the striped shirt, and the little veins around the nose.

Philip van Damme, a dentist and concerned reader of the journal, came to the same conclusion. He wrote a Letter to the Editor in which he politely stated that “obviously another management modality, i.e. ‘Photoshopping’, generated the results of the patient”.

The journal then asked the original authors to reply to Van Damme’s concern. Their reply? “Thank you for asking us to comment on the letter received from the reader. The photograph in our article is of the same patient at 6 months post-treatment. The photograph was taken in the same room with a similar environment; unfortunately the patient wore the same shirt.

Not only was it unfortunate that “the patient wore the same shirt”, it was also sad that the journal accepted this excuse.

On its website, Int J Oral Maxillofac Surg claims to be “one of the leading journals in oral and maxillofacial surgery in the world. The Journal publishes papers of the highest scientific merit and widest possible scope on work in oral and maxillofacial surgery and supporting specialties.

Accepting the authors’ statement that these photos were indeed taken 6 months apart but that the patient just wore the same shirt is …. baffling. It shows that IJOMS cares more about cranking out papers than about publishing articles of the “highest scientific merit”. Instead of retracting the original paper, which would have been the proper action in my opinion, they now have three papers for which they can ask $35.95 (the first paper, the letter to the Editor by Van Damme, and the authors’ reply). That is more than $100! Why waste this nice opportunity to earn some extra $$$ by retracting a paper?

IJOMS should to the right thing and retract this paper. If they continue to support asking $100 for this tragic triade, they show they care more about money than about science. In other words, in that case we could consider IJOMS to be a predatory journal.

You can read my official PubPeer concerns here: and I will write to the Editor tonight.

2 thoughts on “Photoshop as a management modality”

  1. I’d like to point out that Twitter user @root42 did an image difference analysis. I replicated that and the results are here:

    A guide to interpreting this image: Dark colour means image similarity, light colour means difference. In other words the fact that the skin lesions are clearly visible while the other facial features vanish shows that the images are the same with the exception of the areas under treatment.


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