Somewhere between very accurate and absolutely off the mark, depending on the method used and how old the missing person is. Age progression of adults tends to be more accurate than young children.
Old school progression pictures were done by an artist – the family of the missing child would be asked to provide pictures of relatives, who they thought the child looked like most, etc. And it was an educated guess to which features should be emphasized.
More modern technology uses image compositing techniques to compile family images and try to figure out a face, but some of them look… Interesting.
At the end of the day an age progression picture, while a potentially useful tool, is more to keep interest alive in the case and keep people thinking about it in the hopes that someone will come forward or remember something.
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