Informed consent in plastic surgery, evaluation of its effectiveness for mutual satisfaction of patient and doctor: Comparison of methods

Quantitative analysis of facial proportions and facial attractiveness among Asians and Caucasians

It has been proposed that the proportions of the human face are crucial for facial aesthetics. If this is the case, we should describe the relationship among proportions of face components quantitatively. This study aims to develop a mathematical model of facial proportions to provide a quantitative description of facial attractiveness. Furthermore, we expect that plastic surgeons can use models in clinical work to enhance communication efficiency between doctors and patients. Face alignment technique was used to analyse 5500 frontal faces with diverse properties (male/female, Asian/Caucasian, ages) to obtain the ratios among the nose length ($ {N}_{L} $), the nasal base width ($ N $), and the inner canthus width ($ {E}_{I} $). A mathematical model ($ {N}_{L}^{2} = a{E}_{I}\mathrm{*}{N}_{L}+b{E}_{I}\mathrm{*}N+cN\mathrm{*}{N}_{L} $) was developed to describe the relationship among these proportions. To validate the effectiveness of this approach, we simulated the post-operative photos using Adobe Photoshop. Our findings show that the ratio of nose length to nose width, the ratio of inner canthus width to nose length and the ratio of inner canthus to nose width play a significant role in determining facial attractiveness. These results provide a possible strategy to quantitatively describe the relationship among human face proportions.

The Makings of a Positive Patient Experience: A Comprehensive Analysis of Plastic Surgery Online Reviews

BACKGROUND

Subjective online physician evaluation is an important component of patient decision-making. Understanding reviews may improve satisfaction and build positive online reputation.

OBJECTIVES

Our objective was to analyze and compare the top predictive factors driving patient satisfaction across the most popular plastic surgery procedures.

METHODS

Online reviews were analyzed from RealSelf, Yelp, and Google for the five highest-rated plastic surgeons of the six metropolitan areas. Blank, non-English, consultation, duplicate, and unrelated reviews were excluded. Data from free-text reviews included physician rating, patient-reported reasons for rating, procedure, and complications. Univariate analysis was performed to compare predictive factors of online ratings.

RESULTS

11,078 reviews were included. RealSelf the highest average rating (4.77), while Yelp had the lowest (4.66). Reviews in Miami, Philadelphia, New York City, and Chicago were mostly published on RealSelf, while Houston and Los Angeles most used Google and Yelp, respectively. Reconstructive procedures were rated significantly higher than cosmetic procedures (p = 0.035). Aesthetic appearance was the strongest predictor of rating across all procedures. Buccal fat removal (98.8%) and abdominoplasty (98.1%) had highest satisfaction, while Brazilian butt lift had the lowest (88.2%) (p < 0.001). Additional significant contributors included staff interaction, bedside manner, health outcomes, complications, and postoperative care (p < 0.001).

CONCLUSIONS

While aesthetic outcome is an important predictor of satisfaction, other aspects of care, such as bedside manner and staff interaction, provide an important foundation of support. Excellent patient-surgeon communication and postoperative care may mitigate patient dissatisfaction and elicit high-satisfaction online patient reviews.

Developing Core Outcome Sets (COS) and Core Outcome Measures Sets (COMS) in Cosmetic Gynecological Interventions: Protocol for a Development and Usability Study

Background

Studies evaluating cosmetic gynecological interventions have followed variable methodology and reported a diversity of outcomes. Such variations limit the comparability of studies and the value of research-based evidence. The development of core outcome sets (COS) and core outcome measures sets (COMS) would help address these issues, ensuring a minimum of outcomes important to all stakeholders, primarily women requesting or having experienced cosmetic gynecological interventions.

Objective

This protocol describes the methods used in developing a COS and COMS for cosmetic gynecological interventions.

Methods

An international steering group within CHORUS, including health care professionals, researchers, and women with experience in cosmetic gynecological interventions from 4 continents, will guide the development of COS and COMS. Potential outcome measures and outcomes will be identified through comprehensive literature reviews. These potential COS and COMS will be entered into an international, multi-perspective web-based Delphi survey where Delphi participants judge which domains will be core. A priori thresholds for consensus will get established before each Delphi round. The Delphi survey results will be evaluated quantitatively and qualitatively in subsequent stakeholder group consensus meetings in the process of establishing “core” outcomes.

Results

Dissemination and implementation of the resulting COS and COMS within an international context will be promoted and reviewed.

Conclusions

This protocol presents the steps in developing a COS and COMS for cosmetic gynecological interventions. Embedding the COS and COMS for cosmetic gynecological interventions within future clinical trials, systematic reviews, and practice guidelines could contribute to enhancing the value of research and improving overall patient care.

Trial Registration

Core Outcome Measures in Effectiveness Trials (COMET) 1592; https://tinyurl.com/n8faysuh

International Registered Report Identifier (IRRID)

PRR1-10.2196/28032

Characterization of Medical Malpractice Litigation After Rhinoplasty in the United States

BACKGROUND

When complications following rhinoplasty occur or when the desired outcome is not achieved, patients may seek litigation on the premise that there was a violation in the standard of care. Knowledge of malpractice claims can inform rhinoplasty surgeons on how to minimize risk of future litigation as well as improve patient satisfaction.

OBJECTIVES

The aims of this study were to identify motives for seeking medical malpractice litigation after rhinoplasty, and to examine outcomes of malpractice litigation after rhinoplasty in the United States.

METHODS

The Westlaw legal database was reviewed for all available court decisions related to malpractice after rhinoplasty. Data collected and analyzed included plaintiff gender, location, specialty of defendant(s), plaintiff allegation, and adjudicated case outcomes.

RESULTS

Twenty-three cases were identified between 1960 and 2018, located in 12 US states; 70% of the plaintiffs were female. Otolaryngologists were cited in 11 cases, whereas 12 cases involved a plastic surgeon. All cases alleged negligence. Cases involved "technical" errors (69.6%), "unsatisfactory" outcomes (39.1%), inadequate follow-up or aftercare (30.4%), issues with the informed consent process (21.7%), unexpectedly extensive surgery (8.7%), improper medication administration (4.3%), and failure to recognize symptoms (4.3%). Twenty of the 23 adjudicated cases (86.9%) were ruled in favor of the surgeon. The main contributing factor in cases alleging malpractice was poor aesthetic outcome/disfigurement (60.7%).

CONCLUSIONS

Malpractice litigation after rhinoplasty favored the surgeon in the majority of the adjudicated cases reviewed. The principal reason for litigating was dissatisfaction with aesthetic outcomes. Rhinoplasty surgeons may mitigate possible litigation by developing a positive doctor-patient relationship, clearly understanding the patient's surgical expectations, and obtaining detailed informed consent while maintaining frequent and caring communication with the patient.

Written Informed Consent-Translating into Plain Language. A Pilot Study

Background: Informed consent is important in clinical practice, as a person’s written consent is required prior to many medical interventions. Many informed consent forms fail to communicate simply and clearly. The aim of our study was to create an easy-to-understand form. Methods: Our assessment of a Polish-language plastic surgery informed consent form used the Polish-language comprehension analysis program (jasnopis.pl, SWPS University) to assess the readability of texts written for people of various education levels; and this enabled us to modify the form by shortening sentences and simplifying words. The form was re-assessed with the same software and subsequently given to 160 adult volunteers to assess the revised form’s degree of difficulty or readability. Results: The first software analysis found the language was suitable for people with a university degree or higher education, and after revision and re-assessment became suitable for persons with 4–6 years of primary school education and above. Most study participants also assessed the form as completely comprehensible. Conclusions: There are significant benefits possible for patients and practitioners by improving the comprehensibility of written informed consent forms.