title: A quality rating scale for aesthetic surgical procedures.
abstract: BACKGROUND
  Cosmetic dermatologic procedures offer the promise of visible aesthetic enhancement with minimal risk. While in recent years the number of available procedures has proliferated, there are few objective methods for evaluating the relative quality of these procedures for particular indications or specific patients.
  
  
  OBJECTIVE
  (A) To develop a simple, easy-to-use numerical rating scale to assess the quality of cosmetic surgical procedures on a range of parameters pertaining to clinical efficacy and patient satisfaction; (B) to statistically validate the discriminative value of this rating scale.
  
  
  METHODS
  (A) Patient and physician interviews were performed to elicit a list of factors that may collectively characterize the clinical efficacy and patient tolerability of cosmetic dermatologic procedures. A 0-100 point rating scale was developed based on these factors, with the face-validity of this scale checked by a group of patients and physicians; (B) Statistical analysis of the questionnaire was performed by asking 15 expert cosmetic dermatologic surgeons to use it to rate 23 common cosmetic dermatologic procedures, and analyzing the results.
  
  
  RESULTS
  (A) An easy-to-use scale was constructed to assess the quality of cosmetic dermatologic procedures by rating the associated cost, risk, time (procedure and recovery), discomfort, results, and longevity of benefit. A "physician adjustment factor" was used to further increase the relevance of this 0-100 point scale for specific patients; (B) Repeated-measures analysis of variations (ANOVAs) performed on the data from the survey of experts demonstrated that this scale can be used to discriminate between common dermatologic procedures. The differences in mean subscores and total scores among procedures grouped by anatomic site and target lesion-type were significant at the level of P < .05.
  
  
  CONCLUSIONS
  Patient preferences exogenous to the rating scale may increase or decrease the suitability of specific procedures.
  
  
  CONCLUSIONS
  Common cosmetic dermatologic procedures are of uniformly high quality, as per expert ratings on a systematic measure. This quality rating scale appears statistically valid and robust, given that expert raters assigned similar ratings to the same procedures but mean ratings were different across procedures. In the future, this quality rating scale can be used to assess novel interventions, and to help dermatologic surgeons faced with patient concern to optimally select among alternative procedures for a given indication.
authors.affiliation: Department of Dermatology, Northwestern University, Chicago, Illinois, USA. murad@alam.com
authors.forename: Murad
authors.initials: M
authors.lastname: Alam
authors.forename: Jean
authors.initials: J
authors.lastname: DesJardin
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Arndt
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Dover
authors.forename: Robert M
authors.initials: RM
authors.lastname: Hodapp
authors.forename: Leslie
authors.initials: L
authors.lastname: Baumann
authors.forename: Harold J
authors.initials: HJ
authors.lastname: Brody
authors.forename: Jean B
authors.initials: JB
authors.lastname: Carruthers
authors.forename: William P
authors.initials: WP
authors.lastname: Coleman
authors.forename: Jerome M
authors.initials: JM
authors.lastname: Garden
authors.forename: Roy G
authors.initials: RG
authors.lastname: Geronemus
authors.forename: Richard G
authors.initials: RG
authors.lastname: Glogau
authors.forename: Carolyn I
authors.initials: CI
authors.lastname: Jacob
authors.forename: Bruce E
authors.initials: BE
authors.lastname: Katz
authors.forename: Arnold William
authors.initials: AW
authors.lastname: Klein
authors.forename: Madeline C
authors.initials: MC
authors.lastname: Krauss
authors.forename: Naomi
authors.initials: N
authors.lastname: Lawrence
authors.forename: Ronald L
authors.initials: RL
authors.lastname: Moy
authors.forename: Rhoda S
authors.initials: RS
authors.lastname: Narins
authors.forename: Neil S
authors.initials: NS
authors.lastname: Sadick
authors.forename: Michael S
authors.initials: MS
authors.lastname: Kaminer
mesh_terms: D019274:Botulinum Toxins, Type A / Q000627:therapeutic use; D002615:Chemexfoliation; D003452:Cryosurgery; D003657:Decision Making; D003869:Dermabrasion; D006801:Humans; D053685:Laser Therapy; D015187:Lipectomy; D009465:Neuromuscular Agents / Q000627:therapeutic use; D017060:Patient Satisfaction; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000191:economics; D011795:Surveys and Questionnaires
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A