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Examining Objective Outcome Measures in Aesthetic Surgery: The Case of Apparent Age
Russell S. Frautschi, B.S.; Eliana F. Duraes, MD; Kashyap K. Tadisina, MD; Rafael A. Couto, MD; James E. Zins, MD
Case Western Reserve University School of Medicine; Cleveland Clinic
2017-02-20
Presenter: Russell Frautschi
Affidavit:
This abstract represents original work which Russell Frautschi has contributed significantly to, specifically in data collection, interpretation, and manuscript writing.
Director Name: James Zins
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Aesthetics
Background:
Although the literature is replete with favorable facelift results, there are few validated facial rejuvenation outcome measures. Apparent age (AA), a visual estimate of age by objective observers, has been utilized in several studies; although attractive, AA lacks validation. Thus, the aim of this study is to examine the reliability of AA, highlighting the importance of the exclusive use of validated outcome measures in future studies.
Methods:
Ten blinded reviewers assessed pre- and post-operative photographs of 32 patients who underwent facelift. Each reviewer completed 3 surveys at 3-month intervals composed of 40 randomly ordered photos; totaling 1,200 photographs assigned an AA. The intra-class correlation coefficient was classified as "excellent", "good", "fair", or "poor." The accuracy of assigned AA, agreement within 5 years, and reduction in AA were also evaluated.
Results:
The mean difference of preoperative true age from assigned AA was 2.74±4.36 years. Forty-three percent of raters were within 5-years (±2.5) of the mean. Intra-rater reliabiliity preoperatively and postoperatively were 0.77, 95% CI:[0.82-0.72] and 0.75, 95% CI:[0.79-0.71], respectively. Inter-rater reliability preoperatively was 0.98. 95% CI:[0.99-0.96], while postoperatively was 0.95, 95% CI:[0.99-0.95]. Mean AA reduction was 5.23±2.81, with a intra-rater reliability 0.15, 95% CI:[0.03-0.34] and inter-rater reliability 0.65, 95% CI:[0.84-0.38].
Conclusion:
Using current statistical measures and analysis, AA is an acceptable tool for pre- and post- operative facial evaluation when assessed by a group of 10 reviewers. Therefore, apparent age represents a reliable and valid objective observer assigned measure for evaluation of facelift outcomes.
