The QuanTificaTion Process

When perusing a plastic surgery journal or attending a plastic surgery meeting, it is evident that the results shown in any given aesthetic presentation are considered by some to be excellent, whereas others deem the same results to be average or less than optimal. This disparity occurs when the interpretation of posttreatment results is based solely on subjective opinion. Certainly, the task of quantifying the results of aesthetic surgery (rather than just subjectively assessing their quality) is immense, but it is essential for aesthetic surgery to follow the trend toward evidenced-based medicine (EBM) that is becoming ingrained in the fabric of the medical profession as a whole. In fact, the quantification of aesthetic surgery results has more far-reaching ramifications than simply determining objective measures by which results can be judged. Objectively assessing the results of our cosmetic surgeries has the potential to change the way surgery is performed. As we all learn more about the philosophies behind EBM (eg, in the Editorial1 by Dr. Felmont Eaves and Dr. Andrea Pusic in this month’s issue, on page 117), it is helpful to also find support among colleagues who have begun implementing it in their own practices. To that end, we would like to share with you the ways in which adding quantitative outcomes assessment, which is the cornerstone of EBM, has changed some of our own clinical approaches. Rigorous research has been conducted and published on how to quantify (instead of merely qualify) patient satisfaction outcomes.2-4 However, as Millard5 taught us, patient satisfaction or dissatisfaction with surgical results should never dissuade us from critically evaluating the results themselves objectively. Thus, it is necessary for us, as plastic surgeons, to adopt a twopronged approach to the critical evaluation of our surgical results: we must understand our patients’ satisfaction/ dissatisfaction with those results and conduct objective evaluations of them. Our ultimate goal in this editorial is to introduce a practical framework for incorporating quantitative analysis measurements into the clinical practice of aesthetic surgery. To begin, it is important that we recognize that what is considered “aesthetic” is based, at least partially, on previous life experiences. A classic example of this from popular media is the nevus on supermodel Cindy Crawford’s left cheek. It is an abnormality, but because a previous cultural beauty icon, Marilyn Monroe, had a similar nevus, Crawford’s nevus is considered attractive. There is no method by which we can quantitate this aspect of aesthetics because it varies tremendously between individuals and can sometimes even lead to certain individuals finding considerably unattractive appearances pleasing. Thus, our discussion about quantifiable results will be limited to the “non-environmentally influenced” aspects of aesthetics.