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Happy and Unhappy Patients: A Quantitative Analysis of Online Plastic Surgeon Reviews for Breast Augmentation

Dorfman, Robert, G., M.Sc.; Purnell, Chad, M.D.; Qiu, Cecil, B.A.; Ellis, Marco, F., M.D.; Basu, C., Bob, M.D., M.P.H.; Kim, John Y., S., M.D., M.A.

Plastic and Reconstructive Surgery: May 2018 - Volume 141 - Issue 5 - p 663e–673e
doi: 10.1097/PRS.0000000000004268
Cosmetic: Special Topics
Press Release
Discussion
Psychosocial Insights
Video Discussion

Background: Online reviews have become modern versions of the word-of-mouth recommendation, and prospective patients are increasingly consulting them before making decisions about their surgical care. The authors’ objectives were to (1) identify trends in the use of online reviews, and (2) important reasons for patient satisfaction and dissatisfaction with aesthetic surgery. The authors selected breast augmentation as the primary procedure of interest.

Methods: Reviews of the top 10 to 20 most reviewed plastic surgeons in each of six large metropolitan areas were obtained from Google, Yelp, and RealSelf. Reviews were assessed for predefined dimensions of satisfaction and dissatisfaction.

Results: A total of 1077 breast augmentation reviews were obtained. Ratings were distributed bimodally, with peaks at five stars and one star. The majority of reviews were positive (87.5 percent). Relative popularity of Google versus Yelp varied across geographic regions, and average rating varied by platform. Between 2011 and 2016, the number of online reviews for breast augmentation grew at an average rate of 42.6 percent per year. Aesthetic outcome was the most commonly cited dimension (69.8 percent of reviews), whereas cost was mentioned in only 7.8 percent of reviews. A substantial minority of negative Yelp (37 percent) and Google (9.4 percent) reviews were written by patients who did not actually undergo surgery. Free-text analysis of heterogeneous reviews (containing positive and negative attributes) classified dimensions as critical, redeemable, or protective.

Conclusion: As the influence of online review platforms continues to grow, understanding drivers of positive and negative reviews may help surgeons improve patient satisfaction.

Psychosocial Insights for this Article are on Page 671e.Video Discussion by Debra Johnson, M.D., is Available Online for this Article.

Chicago, Ill.; and Cypress, Texas

From the Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine; and the Division of Plastic Surgery, North Cypress Medical Center.

Received for publication May 3, 2017; accepted November 20, 2017.

Disclosure: None of the authors has a financial interest in any of the products or devices mentioned in this article.

A Video Discussion by Anne Taylor, M.D., accompanies this article. Go to PRSJournal.com and click on “Video Discussions” in the “Digital Media” tab to watch.

John Y. S. Kim, M.D., M.A., Division of Plastic Surgery, Northwestern University Feinberg School of Medicine, 675 North St. Clair Street, Suite 19-250, Chicago, Ill. 60611, john.kim@nm.org

The Internet has come to play a central role in how modern patients seek information when making health care–related decisions. Recent evidence suggests that as many as 59 percent of Americans view online reviews as at least “somewhat important” when choosing a physician, and that 33 percent of adults are “greatly affected” by such reviews.1 , 2 Cohen and colleagues call physician ratings a paradigm shift in American health care, claiming that such subjective evaluation of physician performance will only intensify in the coming years.3 The authors claim that online ratings may even influence patients’ perception of what constitutes a “good doctor.” Although aesthetic surgeons may already be attuned to online reputation, such reviews will likely impact even the most respected plastic surgeons in the years to come.3

Nevertheless, as of 2017, most publications examining Internet and social media use in plastic surgery focus on their utility in growing a practice and educating patients.4–12 There is a paucity of literature quantitatively and specifically evaluating online plastic surgery reviews.

Studies have begun to examine the role of peer-sourced reviews on the modern practice of plastic surgery.13 , 14 In their study of aesthetic surgery on RealSelf, Domanski and Cavale compared satisfaction rates for popular procedures and found that abdominoplasty had the highest “Worth It” rating among aesthetic surgical procedures.13 Khansa et al. analyzed online reviews by patients on RealSelf to identify reasons for dissatisfaction with rhinoplasty.14 However, neither study examined granular aspects of the patient encounter, such as bedside manner, listening skills, competence, visit duration, or features related to ancillary staff.15 , 16

Understanding patient preferences and drivers of satisfaction may, in turn, help plastic surgeons provide more responsive care to their patients. We therefore set out to evaluate attributes of positive and negative online plastic surgeon reviews to fill this gap in knowledge. Many online platforms for patient reviews exist, including Google, Yelp, RealSelf, Healthgrades, and Real Patient Ratings, among others. Accordingly, we chose to analyze patient reviews from Google and Yelp because of their popularity and authority, and RealSelf because of its specificity for plastic surgery and inclusion in prior studies.13 , 14 Our objectives were twofold: (1) to identify common reasons for patient satisfaction and dissatisfaction with plastic surgeons, and (2) to evaluate the usefulness and reliability of online reviews as a methodology for understanding the patient experience. Given that breast augmentation is one of the top two most commonly performed aesthetic surgical procedures in the United States, we decided to focus our analysis on reviews of breast augmentation.17 , 18

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PATIENTS AND METHODS

Three online platforms for customer reviews were included in our analysis: RealSelf (www.realself.com), Yelp (www.yelp.com), and Google (www.google.com). Data were obtained en masse from RealSelf and Yelp by means of a “Web crawling” computer program written in R with the XML package (www.r-project.org). Because of incompatibility with the XML package, data from Google (www.google.com) were obtained manually. The data for this study were obtained between December of 2016 and January of 2017.

We chose six metropolitan areas of interest: New York, Los Angeles, Chicago, Houston, Philadelphia, and Miami. The first five of these cities were included because they represent the five most populous metropolitan areas in the United States, based on 2015 U.S. Census data.19 Miami was included because it has the most plastic surgeons per capita of any metropolitan area in the United States.20 Data from Yelp and Google Reviews were collected on a per-business basis for each metropolitan area. For Yelp, our Web crawler identified the 20 most-reviewed businesses for the lay search terms “plastic surgeon,” “aesthetic surgeon,” and “breast augmentation.” For Google reviews, the 10 most-reviewed businesses with the tag “plastic surgeon” were manually identified. For each of these businesses, all user ratings (five-star scale) and free-text reviews were analyzed.

Unlike Google and Yelp, RealSelf is unique in that patients have the opportunity to evaluate surgeon and procedure separately. For proper comparison, we collected data from RealSelf on a per-user basis within the breast augmentation category of surgeon reviews only. Key data points from RealSelf included treatment date, satisfaction level (“Worth It,” “Not Sure,” or “Not Worth It”), and free-text review of the surgeon.

Reviews were included in our analysis if they were written in English, were applicable to primary breast augmentation, and specified a particular reason for satisfaction or dissatisfaction (i.e., blank reviews were excluded). An additional inclusion criterion was that the physician being reviewed be a board-certified plastic surgeon. A positive review was defined as having four or five stars on Google and Yelp, or a Worth It rating on RealSelf. Patients leaving a positive review were considered to be satisfied.14 A negative review was defined as having one or two stars on Google and Yelp, or a Not Worth It rating on RealSelf. Patients leaving a negative review were considered to be dissatisfied.14 Reviews with three stars on Google and Yelp, or Not Sure on RealSelf, were excluded from this aspect of the analysis.

Data were then tabulated and free-text reviews were assessed independently by three researchers using a modified grounded theory approach.21 Specifically, dimensions of patient experiences were selected first by an assessment of the literature and validated patient surveys. Then, after independent assessment of 100 reviews during which the researchers identified additional factors that drove reviewer satisfaction or dissatisfaction, the researchers discussed and agreed on a common set of dimensions by which all patient reviews would be assessed (Table 1).

Table 1

Table 1

All analyses were performed using SAS JMP Pro 12 (SAS Institute, Inc., Cary, N.C.). Categorical variables were compared using the chi-square test or two-proportion Z test. Continuous variables were compared using a t test. Differences across metropolitan areas and review platforms were assessed using the analysis of variance test. Odds ratios were used to evaluate the relative impact of review dimensions on rating. For all statistical tests, significance was defined at α = 0.05.

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RESULTS

We abstracted a total of 3529 Google reviews and 5618 Yelp reviews. Basic summaries for Google and Yelp reviews are presented in Tables 2 and 3.

Table 2

Table 2

Of 9451 reviews from Google and Yelp, 843 reviews met inclusion and exclusion criteria for content analysis. These comprised 387 Google reviews (355 positive and 32 negative reviews) and 456 Yelp reviews (426 positive and 30 negative reviews). The number of reviews on both of these platforms has grown over time, at an average rate of 42.6 percent per year since 2011, driven predominantly by a 51.4 percent annual growth rate among Yelp reviews (Fig. 1).

Fig. 1

Fig. 1

At the time of data collection, breast augmentation had a 97 percent total Worth It rating on RealSelf, with 187 Not Worth It reviews. All 187 Not Worth It surgeon reviews on RealSelf were assessed manually, with 80 reviews ultimately meeting inclusion criteria. A random sample of 250 Worth It surgeon reviews was also reviewed, and of these, 154 met inclusion criteria.

In total, we assessed 1077 reviews across all platforms, comprising 935 positive and 142 negative reviews. The frequencies by which each dimension was mentioned in reviews are displayed in Figure 2 and Table 4. Good aesthetic outcome (n = 643), good bedside manner (n = 573), office staff friendly and/or helpful (n = 520), has expertise (n = 405), and listened to patient (n = 332) were the top five most commonly mentioned reasons for patient satisfaction in positive reviews. Reasonable cost (n = 37) was the least commonly mentioned reason for patient satisfaction on all Web sites sampled in our study. Poor aesthetic outcome (n = 71), does not listen to patient (n = 57), not competent (n = 50), does not acknowledge or take responsibility for poor outcome (n = 47), and too expensive (n = 40) were the top five most commonly mentioned reasons for patient dissatisfaction in negative reviews.

Table 3

Table 3

Table 4

Table 4

Fig. 2

Fig. 2

Of 142 negative reviews meeting inclusion criteria, 71 reviews listed poor aesthetic outcome as a reason for dissatisfaction. Subset analysis of these reviews revealed that 25 reviews did not specify a reason for why their aesthetic outcome was poor. Results of the subanalysis for the remaining 46 negative reviews are demonstrated in Figure 3. Asymmetry [n = 28 (60.9 percent)] and implant malposition [n = 19 (41.3 percent)] were the two most commonly reported reasons for poor aesthetic outcome in negative reviews. These were followed by patient dissatisfaction with size [n = 12 (26.1 percent)], scarring [n = 10 (21.7 percent)], and ptosis [n = 5 (10.9 percent)] as additional reasons for poor aesthetic outcome, respectively.

Fig. 3

Fig. 3

Reviews came from 60 businesses on Google Maps and 113 businesses on Yelp (only 13 businesses were identified in Philadelphia by our search terms). On Google, the average number of reviews per business was 63.9. On Yelp, the average number of reviews per business was 49.7.

Quantity of reviews varied across metropolitan areas, but average rating did not. Los Angeles had the most Yelp reviews for plastic surgeons (3000), and Miami had the most Google reviews (2344) (Fig. 4 and Table 3). Philadelphia had the fewest reviews for both Yelp and Google (Yelp, 164 reviews; Google, 190 reviews). Indeed, the number of reviews per business was significantly different across metropolitan areas by analysis of variance (p < 0.01 for Yelp; p = 0.03 for Google). Chicago demonstrated the highest average rating on Google (4.9), whereas Los Angeles was highest on Yelp (4.6) (Table 3). Houston had the lowest average rating on Yelp (3.8). However, variation in average rating was statistically insignificant (p = 0.07 for Yelp; p = 0.27 for Google) across cities.

Fig. 4

Fig. 4

The mean rating for plastic surgeons on Google was higher than on Yelp (4.66 versus 4.39; p < 0.01). Distribution of ratings was distributed bimodally on both platforms, with local maxima at one star and five stars with minima at three stars. The proportion of one-star ratings was larger on Yelp (12 percent) than on Google (3.5 percent). The average word count per review was 124.3; however, there was a strong negative association between star rating and word count (R 2 = 0.90 for Google; R 2 = 0.92 for Yelp) (Fig. 5 and Table 5). Altogether, a majority (87.5 percent) of reviews of plastic surgeons across Google and Yelp were positive.

Table 5

Table 5

Fig. 5

Fig. 5

During assessment of reviews, we identified reviews that contained both positive and negative dimensions (called “heterogeneous” reviews), which enabled us to infer relative importance of dimensions by means of the calculation of odds ratios. We identified 51 heterogeneous reviews of 1077 total reviews (4.7 percent), 37 of which were positive reviews and 14 of which were negative.

All computed odds ratios were found to be statistically significant at α = 0.05 (Table 4), confirming that the dimensions associate with positive and negative reviews. The largest odds ratios included 1932 for perceived skills of the surgeon, 1873 for aesthetic outcome, and 1121 for surgeon attentiveness. The lowest odds ratio was 96 for time spent with the patient. Among the negative Yelp reviews, 37 percent were from reviewers who did not receive surgery from the surgeon they were reviewing. Conversely, no positive reviews were attributed to patients who had a consultation but did not undergo breast augmentation.

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DISCUSSION

Online reviews continue to play an increasing role in influencing consumer choice of surgeon, making it essential for plastic surgeons to understand the factors that may influence a patient to leave a positive or negative review. Our study was designed to help elucidate these factors for breast augmentation, one of the top two most commonly performed aesthetic operations.17 , 18

As is so often the case on the Internet, negative voices can be the loudest on review sites. Although the vast majority (87.5 percent) of reviews of plastic surgeons online were positive, the word count of negative reviews was higher than that of positive reviews. A dissatisfied patient will likely take up more screen real estate on a review site, and this may have real consequences for surgeons. Studies of movie and media sites have found that negative online reviews deter customers and decrease sales.22–24 Following up with patients who leave negative reviews, as Nathan et al. suggest, may help minimize damage to one’s reputation.25 However, publicly airing such discussion online is not advised because of Health Insurance Portability and Accountability Act of 1996 violation risks.26 Rather, a generic reply without exposing any patient-specific information may be an option in some cases.

Unfortunately, because of the Health Insurance Portability and Accountability Act of 1996, surgeons have little power in contesting online patient reviews, and this underscores the potentially unfair asymmetry of information presented on these review platforms. Online reviews are generated from self-selected respondents, and those with more extreme positive or negative feelings may be more likely to leave reviews than those whose feelings lie somewhere in between.14 Indeed, our results demonstrate the skewed bimodal distribution of one- and five-star reviews, with few moderate reviews in between—strong feelings elicit strong reactions, and these convert to voluntary acts of reviews online. That high word count associated with negative reviews suggests that patients have more to express when they are dissatisfied with their experience.

Among negative reviews, poor aesthetic outcome was most commonly attributed to asymmetry and implant malposition, but we also identified a recurrent theme of discordance between surgeon- and patient-perceived outcomes, where the surgeon felt that their work was well done but the patient was unhappy with their own appearance. Of course, the patient’s perspective of a poor outcome may not necessarily represent a technical failure of the operation. Patient perception of the quality of their result is likely related to preoperative counseling and expectations, actual technical result, and how the surgeon handles postoperative care.27–29 Several studies have demonstrated that patient and surgeon assessment of aesthetic outcomes often disagree.30–34 A patient’s misinterpretation of the aesthetic outcome—or discordant views between surgeon and patient—may lead to a patient (mis)perception that the surgeon is “failing to take responsibility.” This may also cause patients to feel that their surgeon is not listening, which was another top five reason for dissatisfaction. Thus, the study findings lend credence to the notion of establishing a strong foundation of reasonable expectations. Multiple prior studies have demonstrated accordingly that physicians with the best patient communication skills also had the highest patient ratings and satisfaction.35–37

Interestingly, although breast augmentation has often been lauded as a “commoditized” surgical procedure,38 we found that reasonable cost was the least commonly mentioned reason for patient satisfaction on all Web sites sampled in our study. Satisfied patients alluded to their provider’s competence and bedside manner far more than they did to price of the procedure. This is in accordance with findings of previous studies that found relative cost of procedures was the least important reason for patient satisfaction with their plastic surgeon.39 , 40 Domanski and Cavale, who evaluated Worth It ratings for popular procedures on RealSelf, likewise found that cost did not appear to impact the Worth It score.13 Price sensitivity among patients may be subject to variation, depending on the socioeconomic status of the population being sampled.41 However, the caveat to this is that patients may be hesitant to note in a public review that price significantly affected their choice.

Notably, 36.7 percent of negative Yelp reviews and 9.4 percent of negative Google reviews were written by patients who had only consultations but not surgery. Major themes among these reviews included “rudeness” and “curtness” of the surgeon, brevity of consultations, and the perception that the surgeon was “greedy.” These sentiments stopped the reviewers from proceeding with surgery but motivated them to leave negative reviews online. In contrast, no positive reviews were attributed to reviewers who did not undergo surgery. This highlights the importance of the presurgical consultation in protecting a surgeon’s aggregate rating: a bad consultation experience can lead to negative reviews, but a good consultation is only one step toward a positive one. Because Yelp allows patients who had even cursory interactions with a business to publish reviews, surgeons who want to protect their aggregate rating must consider the patient experience through all phases of the interaction, not only during and after surgery.

Our analysis of all reviews across all procedures and experiences garnered by plastic surgeons identified by our Web search further demonstrates differences across platforms and metropolitan areas. On the whole, reviews on Google were more favorable than those on Yelp (p < 0.01), and this relationship was also observed in each metropolitan area (Table 3). The difference was marked in Houston, where the average Google rating was 4.7 and the average Yelp rating was 3.8 despite 60 percent overlap in surgeons reviewed. The number of reviews per surgeon varied across metropolitan areas on both Google and Yelp independently (p = 0.03 for Google; p < 0.01 for Yelp) (Table 3). These observations suggest differences in user bases or biases across platforms. A nuanced, contextual interpretation of online ratings for a given surgeon should consider these underlying differences in volume and rating tendencies across locations and platforms.

Furthermore, our secondary analysis identified aesthetic outcome, perceived skills of the surgeon, and surgeon attentiveness as having the largest odds ratios, meaning that performance along these dimensions was most influential on patient satisfaction. We categorized these topics as critical traits for satisfaction (Table 6). We further identified rude office staff, little time spent with the surgeon, and experiencing a complication of surgery as negative dimensions that had relatively high rates of satisfaction (25, 22, and 21 percent, respectively). These were categorized as redeemable traits—negative dimensions that can be mitigated by other positive dimensions. The most common mitigating reason for a positive review was good aesthetic outcome; reviewers often expressed the sentiment that even though they encountered negative experiences, they ultimately left a positive review because they liked their aesthetic result. Other notable sentiments expressed in heterogeneous reviews included the following: leaving a positive review despite spending little time with the surgeon because of the perception that their surgeon was an expert with a high-volume practice, and leaving a positive review despite a surgical complication because their surgeon had proactive follow-up and demonstrated empathy through the healing or revision process.

Table 6

Table 6

We were specifically interested in whether poor aesthetic outcome could be overcome. Our data demonstrated that only 5.6 percent of reviews that mentioned a poor aesthetic outcome left a positive rating. Analysis of these reviews revealed that these patients ultimately left positive ratings because of realistic expectations about the possibility of a poor outcome and because of proactive follow-up by the surgeon. Although the rate of positive reviews among patients with poor aesthetic outcomes is too low to label this dimension “redeemable,” it does offer additional evidence that there are some possible actions a surgeon can take to protect his or her online reputation.

By means of sentiment analysis of other heterogeneous reviews, we identified three protective traits: good aesthetic outcome, proactive follow-up, and perceived expertise. Indeed, very few reviewers who had a good aesthetic outcome, who commented on their surgeon’s proactive follow-up, or who mentioned that their surgeon was highly skilled left negative reviews (0.9, 1.2, and 2.3 percent, respectively).

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Limitations

Patient reviews and satisfaction are naturally subjective. Our study is limited to what patients report, which may not necessarily capture all dimensions of their experience. Verification regarding authenticity of online patient reviews likewise remains challenging, and it is certainly possible that some reviews are inauthentic. However, of the 3833 Google reviews manually assessed for this study, there were only five instances in which a plastic surgeon responded and noted that the review was “fake” and not written by a patient of theirs. This does not exclude other fake reviews not flagged by the surgeon. Google, Yelp, and RealSelf all offer tools for reporting false reviews so that they can be removed. However, it remains unknown whether these tools are effective.42 In addition, Yelp has been embroiled in recurring controversies and claims regarding potential links between solicited advertising and favorable review treatment.43

On the contrary, review sites also enable patients to assess their experience with plastic surgery in real time, and thus may more accurately reflect satisfaction and dissatisfaction than surveys administered from physicians’ offices. Furthermore, individual surgeons may even avoid publishing their patient satisfaction ratings if they are subpar.13 However, there is less bias with online reviews that are easily accessible to the public. It is certainly possible that topography of online reviews has changed over the study interval. Perhaps as plastic surgeons have grasped the importance of these review sites, they have responded to what may have been initially a negative complaint platform and have transformed it into a conduit for positive shared experiences. Furthermore, the current study evaluates online reviews relevant only to primary breast augmentation. Additional studies are needed to evaluate online patient reviews applicable to other plastic surgery procedures.

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CONCLUSIONS

In the rapidly changing marketplace of plastic surgery, online reviews are rapidly becoming the new word-of-mouth, with significant potential to influence patient referrals. In our study of 1077 breast augmentation reviews, the vast majority of reviews were positive, with significant variations by platform and geography. Good aesthetic outcome was both critical to and protective of a surgeon’s online rating—notably, it allowed conversion of some negative patient outcomes to positive reviews. Moreover, a reasonable minority of negative reviews were from patients who did not undergo surgery—underscoring the importance of a positive preoperative consultation in overall patient satisfaction. Cost did not appear to factor into positive or negative reviews. In summary, we present the first comprehensive analysis of the factors involved in online breast augmentation reviews. Nuanced understanding of these reviews may allow for development of concomitant surgeon strategies to improve patient satisfaction.

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PSYCHOSOCIAL INSIGHTS

Dr. David B. Sarwer is the Associate Dean for Research, Professor of Social and Behavioral Sciences, and Director of the Center for Obesity Research and Education, College of Public Health, Temple University, Philadelphia, Pa.

Even before the advent of Press-Ganey scores and other hospital-based assessments of patient satisfaction, plastic surgeons have been interested in quantifying the level of satisfaction of patients who have undergone cosmetic procedures. The earliest reports, from decades ago, repeatedly suggested that the vast majority of patients—often about 90 percent—reported directly to their treating surgeon that they were satisfied with a given procedure. Taken at face value, those observations are incredibly impressive. If given a second thought, however, the observations beg two questions. First, what percentage of patients would look their surgeon in the eye and state, “I’m not satisfied with my result”? Second, if that percentage was greater than 10 percent, what percentage of surgeons would share that observation with the larger plastic surgery community in a peer-reviewed publication? The answer to both questions is that direct assessment of patient satisfaction is subject to bias that calls into question the validity of the findings.

The study by Dorfman and colleagues represents a novel approach to investigating patient satisfaction with cosmetic breast augmentation. In a large and geographically diverse sample of patients who had provided online reviews of their breast augmentation experience on one of three well-known websites, the authors found that 87.5 percent of all reviews were positive. This result is consistent with those studies noted above. However, the use of reviews from these websites does not yield a comprehensive or random sample of patients who have undergone cosmetic breast augmentation. As a result, the finding is impacted by respondent bias. Nevertheless, the consistency of the findings across methodologies does provide support for the belief that many patients are quite satisfied with cosmetic breast augmentation and willing to share their positive experience with others.

In several respects, the negative reviews, while less frequent, are more informative to plastic surgeons and other members of the treatment team. Analysis of the negative comments suggests a couple of areas that even high-functioning, successful practices should target in an effort both to further improve overall patient experience and to minimize undesired patient experiences. Patients appear to be dissatisfied when patient-provider communication is poor, inconsistent, or nonexistent. While the communication style or “bedside manner” of the treating surgeon is paramount to a positive patient experience, the results suggest that interactions with other member of the treatment team can also impact patient experience to the negative or positive. All members of the treatment team are encouraged to communicate with patients in a manner that represents a respectful, warm, caring, and supportive health care environment.

The practice environment likely becomes of greatest importance when patients experience complications or unanticipated aesthetic outcomes. In my two decades as a psychologist working with plastic surgery patients both before and after surgery, I have observed that most patients minimize the risk of undesired outcomes. They approach surgery thinking positive thoughts (as they should) and probably assume that complications will happen to other patients. When a complication occurs, or they are dissatisfied with the aesthetic result, patients often report that they feel guilty, as if the negative result is a punishment for their vanity, and often describe the experience as if they were a character in a morality tale. In this situation, patients often benefit greatly from the support and compassion of the treating surgeon and team. If, however, they feel abandoned by the team—that the surgeon tells them their concerns are minimal, stops returning telephone calls, or refuses to see them, the negative feelings often evolve to anger that has the potential to serve as a catalyst to a malpractice suit.

As the authors note, the results of this study, along with those from previous investigations, suggest that positive patient-provider communication is of paramount importance in cosmetic surgery. This starts with the initial consultation, where the surgeon and patient should have explicit discussions about the patient’s expectations regarding the impact of the procedure on their physical appearance, body image, and quality of life. Establishing a strong, compassionate professional relationship at the onset will likely increase overall patient satisfaction rates and also provide an important foundation of support if an undesired outcome occurs.

Disclosure: Dr. Sarwer is currently a member of the Board of Directors of the American Board of Plastic Surgery and the Aesthetic Surgery Education and Research Foundation. He has consulting relationships with Allergan, BARONova, Medtronic, and Novo Nordisk.

©2018American Society of Plastic Surgeons