What is value? Healthcare administrators commonly use an equation to define value: quality of care revenue ÷ cost − risk = healthcare value. As physicians we feel that value essentially means ‘exceeding patients expectations’.
The needs and desires of patients can vary greatly — especially by age. Those between 18 and 35 years of age want to enhance a youthful appearance, essentially to ‘improve natural qualities’. On the other hand, those aged 35–55 years strive to recapture a more youthful appearance and are seeking rejuvenation procedures. Those aged 55 and over are candidates for more restoration procedures. They are usually seeking to maximise an age-appropriate appearance. The common thread in all these groups is a desire to obtain global balance, symmetry, and proportion — regardless of the procedure. However, the state of cosmetic surgery is changing. According to a recent ASPS report, in 2012 Americans spent over $11 billion on more than 14 million cosmetic procedures. Minimally-invasive procedures were up 6%, while surgical procedures were down 2%1.
With so many new products and procedures on the market today, the surgeon must ask him or herself basic questions concerning those products and procedures. The most important question should be directed at the available medical literature rather than the advertising or marketing campaign so common among market-driven cosmetic products and procedures. It is necessary for us to fully understand the products and procedures and be sure they have undergone the test of objective scientific study with clear clinical evaluations and a supportive histology. Only then will we truly know the effectiveness of the agents and procedures we are using.
Today, medicine is being driven to perform in a new, more objective manner with more accountability, and this holds true for the aesthetic field as well. Enter — the practice of evidence‑based medicine. It means integrating our individual clinical expertise with the best available external clinical evidence from systematic research and, in consultation with the patient, deciding on the treatment option which best suits the patient.
Our clinical studies need to be taken to a higher level. Neil Sadick recently emphasised the importance of quality of life studies and the need to take their findings into account as part of our evidence-based evaluation2. New innovations, technologies, and procedures are introduced on the basis of evidence, but often with little critical analysis of costs, risks, or comparison with products or procedures which provide similar outcomes. We need to be more critical of our practices, our preferences, and the evidence we use to determine what recommendations are made to our patients.
Determining the value and appropriateness of a procedure for a specific patient can be difficult. It is plausible that in the future an aesthetic surgery quality rating scale may be able to assist in making such determination.
An aesthetic surgery rating scale may prove to be a viable tool in patient and procedure selection. Surgeons may consider the information provided by a scale in conjunction with their intuition and experience when deciding whether to perform a certain procedure. However, it is important to emphasise that no rating scale can substitute for acute clinical judgment.
Today, it remains a challenging job for the ethical physician to distil the available knowledge and communicate it in a meaningful way to the patient, who must make an informed choice regarding the value of the aesthetic products and procedures they desire.