Recherche évaluative en chirurgie esthétique maxillofaciale

Abstract

The outcome research, like the clinical research, examines the end results of medical interventions. However, unlike clinical research, the outcome research systematically considers outcomes from the patient’s perspective. Therefore, assessments do not focus on physical data or laboratory test, but on the patient’s feelings. This approach is essential in cosmetic surgery where the main outcome is psychological and subjective rather than functional. Outcome research is useful in solving the ethical problem of the risk-benefit ratio in cosmetic surgery. Parallel to its evolution and advances, it should allow a better definition of the indications for cosmetic surgery. In outcome research, the assessment may be an index of satisfaction, a scale for quality of life, or a scale for psychological evaluation. Satisfaction indexes present a great advantage related to their simplicity, but such easiness of response constitutes also a limitation. They are essentially based on visual analogue scales such as those commonly used to assess pain. Evaluation tests for quality of life assessment include in a single score several dimensions such as physical condition, and social, psychological, and emotional criteria. Specific tests take into account the pathology or the need for care as asked by the patient, such as cosmetic surgery. Generic health status tests focus on the quantification of overall quality of life independently from the patient’s demand; this makes them less biased. Finally, psychological scales are the most commonly used due to the psychological aspect of a need for cosmetic surgery. They screen depression, anxiety, etc. A literature review revealed that maxillofacial surgery doesn’t improve depression indexes. It improves significantly self-confidence, self-esteem, and physical self-image. Cosmetic surgery improves the results of generic or specific tests for quality of life assessment, provided these tests include some of such psychological parameters.