Outcomes Research in Facial Plastic Surgery: A Review and New Directions.

Outcomes research is a fast-growing field of study that focuses on patient-related aspects of medical or surgical outcomes such as satisfaction and quality of life. In the realm of facial plastic surgery, many outcomes are subjective evaluations based on the patient and physician's judgment as to the surgical result, but little has been done to quantify these qualitative results in an objective manner. This paper discusses the basis for outcomes research and suggests its application to the field of facial plastic surgery. Four new facial plastic outcomes instruments have been developed and are provided for the potential use in measuring the quality of life results of rhytidectomy, rhinoplasty, blepharoplasty, and skin rejuvenation procedures.

The deep plane facelift.

The goal of any cosmetic facial plastic surgery procedure is to obtain a natural-appearing result that is not overdone or obviously operated upon. This is the case whether the background of the operating surgeon is in facial plastic and reconstructive surgery, general plastic surgery, dermatology, or oculoplastic surgery. To satisfy this goal, the surgeon must apply those techniques that consistently achieve effective but understated results rather than experimenting with every new innovation or fad. More and more surgeons are moving away from some of the so-called advances of the last decade, including the use of lasers for skin resurfacing and the application of endoscopic approaches to the face, in the search for the best results possible. Sometimes this means utilizing older techniques that have proven the test of time, such as the coronal browlift and chemical peels, whereas other times this means embracing those newer techniques that clearly represent major advances in our specialty, such as the transconjunctival approach to lower lid blepharoplasty. The deep plane facelift is one such advance. In contrast to traditional, skin or short-SMAS flap techniques, the deep plane facelift allows the surgeon to consistently obtain a natural-appearing result that not only addresses the key areas of concern in the aging face but also proves to be longer lasting as well. The deep plane technique also results in fewer complications, an improved ability to address the melolabial region and jowls, and increased anatomic appeal for the operating surgeon.

Outcomes instruments in facial plastic surgery.

The accurate measurement of patient-related outcomes of facial plastic surgery procedures relies upon the development, standardization, and use of validated, procedure-specific quality of life instruments. Although other fields of medicine and surgery have embraced the use of such instruments for the quantification and measurement of otherwise subjective or qualitative aspects of patient satisfaction, in the fields of both general and facial plastic surgery, little has been done in this realm. The study of outcomes research and the application of outcomes research to facial plastic surgery have already been discussed in this issue. Outcomes research is founded upon the ability to measure in some fashion those aspects of patient satisfaction that have hitherto been ignored or at best poorly quantified in the assessment of the results of a medical or surgical intervention. In facial plastic surgery, particularly cosmetic facial plastic surgery, the overwhelming majority of results are subjective in nature, be they patient related or based upon the surgeon's own personal assessment of outcome. For this reason, the use of validated instruments to quantify and measure these results is of particular importance in facial plastic surgery compared with other fields of medicine where many outcomes are objectively determined, such as mortality. This article outlines the background of the use of quality of life instruments in the field of outcomes research to provide a basic understanding for the application of such tools to the work of facial plastic surgery. Specific instruments that have already been developed and validated are described as well. Finally, future directions are highlighted that may allow the improved measurement of patient satisfaction as the field of outcomes research in facial plastic surgery continues to evolve.

Outcomes of facial cosmetic procedures.

Facial cosmetic procedures lend themselves to outcomes studies in ways that traditional reconstructive procedures may not. The most important measures of outcome in facial cosmetic surgery are quality of life and patient satisfaction, in contrast to other, more objective measures such as complications or mortality rates. For this reason, outcomes research in facial cosmetic surgery deserves a special focus of attention. In this article, we review outcomes studies for the more common facial cosmetic procedures, discuss in depth what aspects of patient-related satisfaction have been quantified by these existing studies, and highlight the direction that future outcomes research projects may wish to follow. There exists an abundance of potential interesting areas of study in facial cosmetic surgery, and the application of outcomes research methodology to these realms may allow the facial plastic surgeon to better define the success or failure of each individual facial cosmetic surgery procedure.

Cosmetic surgery procedures as luxury goods: measuring price and demand in facial plastic surgery.

OBJECTIVES: To evaluate the relationship between cosmetic facial plastic surgery procedure price and demand, and to test the hypothesis that these procedures function as luxury goods in the marketplace, with an upward-sloping demand curve. METHODS: Data were derived from a survey that was sent to every (N = 1727) active fellow, member, or associate of the American Academy of Facial Plastic and Reconstructive Surgery, assessing the costs and frequency of 4 common cosmetic facial plastic surgery procedures (face-lift, brow-lift, blepharoplasty, and rhinoplasty) for 1999 and 1989. An economic analysis was performed to assess the relationship of price and demand for these procedures. RESULTS: A significant association was found between increasing surgeons' fees and total charges for cosmetic facial plastic surgery procedures and increasing demand for these procedures, as measured by their annual frequency (P