Saturday, February 04, 2006

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™".

The Beauty Vector™ - Slide 1
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.

The Beauty Vector™ - Slide 2
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.

The Beauty Vector™ - Slide 3
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.

The Beauty Vector™ - Slide 4
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.

The Beauty Vector™ - Slide 5
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.


  • Dr. Pearson,

    Your entry about the Beauty Vector and managing a patient's expectations for plastic surgery was very insightful for me. As a slow-to-heal rhinoplasty patient 9 months into recovery, I know how much of an emotional rollercoaster the entire process can be. Before my surgery, it was stressed time and time again that to expect perfection is unreasonable, and that the goal should be improvement. Of course I understood this, but did I really grasp the idea? I never wanted 'perfection' so to speak, I just wanted the nose I had been picturing in my mind. It didn't really occur to me that for all intents and purposes, this was, in fact, expecting perfection--MY idea of perfection. Reading about your Beauty Vector concept has made me aware of that. Actually building a concept of that in my mind has helped me to adjust my thinking. I think wanting the surgery so much for so long made me more inclined to develop my own set of preconceived expections, and although I thought my expectations were reasonable, I never thought to renegotiate them. I wish I would have been able to think about it in this way from the beginning, but it has helped me at this point in my recovery nonetheless.

    Even though I'm not a patient of yours, I wanted to let you know how your insight has affected me and impacted my attitude during the healing process. Thank you!

    Minneapolis, MN

    By Anonymous Anonymous, at October 28, 2008 at 2:50:00 AM EDT  

  • Jessica,

    I'm glad you've found this helpful and I hope your rhinoplasty recovery continues to go smoothly. I developed this idea out of a need to better determine patients' expectations and goals, but it also helps them focus better on what is realistic.

    Thanks for visiting our site. All the best,

    --David C. Pearson, M.D.

    By Blogger David C. Pearson, M.D., at October 28, 2008 at 8:44:00 AM EDT  

  • Now we have all seen photos of botched nose jobs. The media loves to trot out pictures of surgery gone wrong and for some reason many of us like to see them. It's akin to not being able to take your eyes off an auto accident or a fire. Sure, these things happen in life, but rhinoplasty results in general are good. Only about twenty percent of people who have a nose job require a second surgery. That's impressive considering the large number of nose jobs performed in a year.

    By Anonymous Rhinoplasty results, at July 27, 2010 at 10:04:00 AM EDT  

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