Image as Designed is a chain or plastic surgeons located in Stilwater, Steelport and Virtual Steelport and used by The Protagonist as part of their shapeshifting techniques.

In Saints Row the store was able to change the users race and skin tone. In the five-years during The Protagonist's coma, Image as Designed managed to make someone change sex on a whim. This allowed horny games to give their once male boss a sex change.

In the years leading up to Saints Row: The Third IAD was able to give different skin tones, giving the Boss an almost alien appearance.

Dr. Ades works here where he fucks up his patients.

"In one of my stories this is how I was made to look like a retarded duck."
Veteran Child on becoming Duck Face.

"I like to...cut them...a little."
Doctor Ades