How Postop Selfies Are Improving Patient Experience

It usually takes only one or two photographs for plastic surgeon James Zins, MD, to evaluate a patient’s progress in the first days after facial cosmetic surgery.

“Most problems post-surgery are eminently obvious,” he says. “I can immediately see which patients need care right away and which are healing well.”

For about five years, Dr. Zins, Chairman of Plastic and Reconstructive Surgery at Cleveland Clinic, has been instructing patients to send him digital photos of their operative area following outpatient procedure. It’s an extra touchpoint intended to supplement — not replace — in-person follow-up appointments.

“Many patients, especially those who haven’t had facial cosmetic surgery before, are surprised by the swelling and bruising that commonly occur,” he says. “It can be concerning for them. My looking at it and assuring them that it’s normal — or fast-tracking care for urgent issues — helps improve their postop experience and satisfaction.”

What Dr. Zins long suspected is now verified in a study published in the Aesthetic Surgery Journal.

“We designed the study to learn two things: whether the process improved patient experience and whether it increased early detection of postop complications,” says Dr. Zins.

About the study

From August 2015 to March 2016, Dr. Zins texted 57 patients during discharge after cosmetic surgery. In the text, direct from the surgeon’s hospital-authorized and secured smartphone, patients received instructions to reply within 48 to 72 hours with photographs of their surgical area. When the photos arrived, Dr. Zins viewed them and contacted patients by voice or text to discuss findings.

Of the 57 patients, 52 responded to a questionnaire about the process. Of the 52 respondents, 50 (96.2%) reported that the process improved their postoperative experience. Of the 41 respondents that had a prior cosmetic surgery, all 41 (100%) said their postop experience this time was more satisfying than their experience last time.

Three patients (5.8%) had complications that Dr. Zins detected in a smartphone photo. However, all three occurred after the patient’s in-person follow-up visit (typically five to seven days after surgery).

“We had hoped to see an increase in early detection,” says Dr. Zins. “But these complications weren’t apparent in the first 48-72 hours. Patients used the same process, however — texting a photo to my smartphone — to get quick attention for issues that occurred later, usually seven to 11 days after surgery.”

Regardless of the timeframe, the digital photographs taken by patients were of sufficient quality to display details alerting Dr. Zins that urgent care was required.

Managing risks

This process, while valuable to patients, comes with risks, including:

• Patient privacy and security. All patients participating in the smartphone-based program signed a release form, allowing the use of their photos for medical evaluation. A disclaimer on the initial text message from Dr. Zins indicated that photos taken, stored and sent on patients’ smartphones could not be considered secure or HIPAA compliant. Dr. Zins transferred photos from his secure, hospital-authorized smartphone to a HIPAA-compliant medical imaging system and then deleted them from his phone to protect patient confidentiality.
• Abuse of surgeon’s accessibility. Zins welcomed patients to contact him any time during their postoperative course, not limited to the first 72 hours. “Yes, more patients now have direct access to my private phone number,” says Dr. Zins. “There is the potential for overuse. But for the most part, I haven’t experienced that with my patients. The benefit of communicating by smartphone outweighs the possible drawbacks.”
• Added responsibility for the surgeon. “This step does create a little extra work for surgeons because it is in addition to standard in-person follow-ups,” says Dr. Zins. “I managed these communications personally, but other surgeons may prefer to assign them to nurses or advanced practice providers.”

The next step in this research will involve studying the benefit of smartphone photography over longer follow-up periods.

“I suspect that we can prevent some emergency visits long-term,” says Dr. Zins. “Before we relied on smartphone photos, patients that would call to report swelling or bleeding would be sent to an emergency department. Now we may be able to triage those cases differently.”

Dr. Zins encourages more plastic surgeons to consider using this form of virtual early follow-up.

“Telemedicine may be especially helpful in medical specialties where visual assessment is important,” says Dr. Zins. “Cosmetic surgery is certainly one of them.”

Please note: Photo used with permission from publisher. Originally published as: Pozza ED, D’Souza GF, DeLeonibus A, Fabiniani B, Gharb BB, ZSins JE. Patient satisfaction with an early smartphone-based cosmetic surgery postoperative follow-up. Aesthetic Surg J. 2018;38(1):101-109.

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