The proliferation of participatory visual methods (PVMs) in applied research has highlighted new ways of seeing and thinking about research. A core tenant of PVMs is the situated, collaborative, reflexive, and co-constructed nature of the work and resulting findings. However, as these methods gain popularity, there can be a disparity between how PVMs are theorized, imagined, and facilitated. Although the facilitated and reflexive nature of PVMs is generally understood by practitioners, researchers seldom report on pedagogical design of their projects, even though the facilitation of a method, and a researcher’s own lens and orientation to photography will influence the production and reading of images. To achieve greater congruence between paradigm and practice, it may be important to return to fundamental questions about the role of facilitation and the process of crafting and exhibiting images in photovoice in relation to one’s study aims. In this article, I explore the crafted role of image-making in the context of a photovoice project that asked stakeholders to visualize engagement in the local HIV sector. Participants created and exhibited 63 photographs and narratives that relied heavily on metaphor as a crafted strategy. They also created three site-specific photo installations. Through detailing our facilitated process, I illustrate how certain design elements (influenced by my pedagogical and theoretical orientations toward co-theorizing) created the necessary conditions for participants to visualize their ideas through metaphor and installation. In turn, the exhibited images and associated installations created new opportunities for synthesis, dialogue, and dissemination. I conclude with a theoretical discussion of the possibilities for taking a crafted and reflexive approach to image-making in photovoice studies.