Dermatologic Surgery
A quality rating scale for aesthetic surgical procedures

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Background

Cosmetic dermatologic procedures offer the promise of visible aesthetic enhancement with minimal risk. While in recent years the number of available procedures has proliferated, there are few objective methods for evaluating the relative quality of these procedures for particular indications or specific patients.

Objective

(A) To develop a simple, easy-to-use numerical rating scale to assess the quality of cosmetic surgical procedures on a range of parameters pertaining to clinical efficacy and patient satisfaction; (B) to statistically validate the discriminative value of this rating scale.

Methods

(A) Patient and physician interviews were performed to elicit a list of factors that may collectively characterize the clinical efficacy and patient tolerability of cosmetic dermatologic procedures. A 0-100 point rating scale was developed based on these factors, with the face-validity of this scale checked by a group of patients and physicians; (B) Statistical analysis of the questionnaire was performed by asking 15 expert cosmetic dermatologic surgeons to use it to rate 23 common cosmetic dermatologic procedures, and analyzing the results.

Results

(A) An easy-to-use scale was constructed to assess the quality of cosmetic dermatologic procedures by rating the associated cost, risk, time (procedure and recovery), discomfort, results, and longevity of benefit. A “physician adjustment factor” was used to further increase the relevance of this 0-100 point scale for specific patients; (B) Repeated-measures analysis of variations (ANOVAs) performed on the data from the survey of experts demonstrated that this scale can be used to discriminate between common dermatologic procedures. The differences in mean subscores and total scores among procedures grouped by anatomic site and target lesion-type were significant at the level of P < .05.

Limitations

Patient preferences exogenous to the rating scale may increase or decrease the suitability of specific procedures.

Conclusions

Common cosmetic dermatologic procedures are of uniformly high quality, as per expert ratings on a systematic measure. This quality rating scale appears statistically valid and robust, given that expert raters assigned similar ratings to the same procedures but mean ratings were different across procedures. In the future, this quality rating scale can be used to assess novel interventions, and to help dermatologic surgeons faced with patient concern to optimally select among alternative procedures for a given indication.

Section snippets

Cost

Cost is graded from very low (5) to very high (1). Obviously, assessments of cost are relative, and the most meaningful comparison is to the cost of other aesthetic surgical procedures, especially procedures designed to produce similar results. In estimating relative cost, the cost per procedure should be used. For procedures that require several low-cost treatments at intervals to maintain an outcome equivalent to that of a single moderate or high-priced procedure, the additional costs

Results

Since aesthetic procedures are optional, they should offer a reasonable chance of aesthetic improvement. Less efficacious procedures may be attempted when they are very low risk or if the patient is willing to accept a minor change. Procedures that improve the appearance of large areas on the face or very large areas elsewhere on the body are most desirable. While, in general, degree of improvement should be judged by blinded, unbiased observers, to some extent, patients' assessments of a

Methods for testing questionnaire

The proposed rating scale may facilitate comparison of diverse aesthetic surgery procedures, which previously lacked a dedicated measurement instrument. To assess the face validity of this scale, we administered a questionnaire under the auspices of the Cutaneous and Aesthetic Surgery Outcomes Group (CASOG) to 15 dermatologists with active aesthetic surgery practices. Participants were asked to rate 23 common procedures on the 6 parameters in the procedure scale (Table I).

Results of questionnaire testing

Table III, Table IV

Discussion

This quality rating scale is designed to improve physicians' ability to compare the benefits and shortcomings of different cosmetic procedures, both in the abstract, and with regard to their suitability for specific patients. The scale rationalizes and makes explicit the judgments that cosmetic surgeons routinely reach intuitively and unconsciously. As such, the scale offers a transparent, systematic tool that can be used to supplement physician judgment and to facilitate communication between

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There are more references available in the full text version of this article.

Funding sources: None.

Conflicts of interest: None identified.

Preliminary data for this article were presented at the 2002 Annual Meeting of the American Society of Dermatologic Surgery.

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Copyright © 2006 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.