Actually, acromegally has a bit different look. Its more the prominance of the supraorbital frontal bones (frontal bossing) and jaw. Increased space between teeth (jaw enlargement), tongue and lip growth. Also, often see the growth of hands and feet in addition to swelling. Sometimes pictures of competitors all dieted down can be misleading. Some people have thicker skull structures naturally. As you pointed out, comparison pictures are most important in recognizing changes in an individual. Not meaning to be insulting, but look at comparison pictures of the former mr. O.
