The Beauty Vector™ and Patient Satisfaction

From time to time any of us who perform cosmetic surgery have to face a patient of ours who is unhappy with his or her result. And when an operation has hasn't gone as well as we'd liked or has suffered complications, a patient's dissatisfaction is justified and understandable.

Some patients, however, are unhappy despite having a technically perfect operation. How can this be? In such cases, the usual reason is the patient's unrealistic expectations about what surgery can do. This underscores one of the most important tasks we have as cosmetic facial plastic surgeons: properly setting patient expectations.

Needless to say, there is no perfect way to do this, but in addition to the usual techniques we're taught in our training, I've recently begun using a concept that I call "The Beauty Vector™".


Figure 1.

Imagine a graph where the vertical axis represents beauty along a scale from "unattractive" to "gorgeous". (see Figure 1.) Pre-operatively, the patient imagines herself (or himself) as lying somewhere along that spectrum—labeled here as "Pre-op". Represented along the horizontal axis is a scale of surgical results, with the extreme right edge representing the theoretically most technically perfect surgery imaginable.

It follows, then, that a patient's appearance will increasingly improve the closer the surgeon comes to executing a technically perfect operation.


Figure 2: a steep Beauty Vector™.

And while it's true that the better the surgery, the better the result, there's another critical factor over which neither the patient nor the surgeon has any control and that's the slope of the line (see Figure 2.).

In figure 2, the patient's Beauty Vector™ is fairly steep. This means that a lot improvement in the patient's appearance is possible—even with surgery that falls short of perfect execution.


Figure 3: a shallow Beauty Vector™.

Some patients, though, have a much shallower Beauty Vector™ such as in Figure 3. What accounts for these differences in slope? The simple answer is: fundamental aspects of a patient's anatomy that are impossible or impractical to modify. These are not limitations of the surgeon's skill, but rather limitations of technology.

Here are a few such examples: we cannot usually modify the position of the eyeball relative to the shape of the eye socket, and yet this relationship helps dictate the height of the upper eyelid; we cannot generally modify skin thickness and yet such factors determine how skin redrapes after rhinoplasty; the position of the hyoid is unalterable and yet it greatly determines how nice a neckline we can create with a facelift.


Figure 4: perception vs. reality.

Problems arise when a patient imagines her (or his) Beauty Vector™ to be a steeper than the surgeon knows it to be (see Figure 4). As the angle widens between medical reality and patient perception, the likelihood that the patient will be unhappy skyrockets, as demonstrated below.


Figure 5: the consequences.

The result for a patient with a shallow Beauty Vector™ is that even a perfect surgical procedure performed by the best surgeon in the world will produce only a modest improvement in appearance (gold and grey dotted lines in Figure 5). But the patient will believe that this modest improvement is the result of mediocre surgery or a mediocre surgeon (blue and grey dotted lines in Figure 5).

As a facial plastic surgeon, the challenge for me is not only to try to come as close as possible to technical perfection with each surgery, but also as importantly to make sure that the patient understands his or her Beauty Vector™, particularly if it is a shallow one.

I want to emphasize that this is not to say that someone with a shallow sloped Beauty Vector™ is never a good candidate for plastic surgery. Rather, a patient is a bad candidate only if his or her expectation of improvement is greater than what is surgically possible.

At Pearson Facial Plastic Surgery™, we're beginning to include a formal estimation of a prospective patient's Beauty Vector™ into the pre-operative evaluation. This helps with our own "quality control," so to speak, and helps create that unique and satisfying experience for our patients.