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Patient Satisfaction After Plastic Surgery Enhanced by Smartphone Contact

“Selfies” help ease patients’ minds


After cosmetic surgery, patients may worry until their follow-up visit if their wounds are healing properly. That common clinical dilemma led James Zins, MD, Chairman of the Department of Plastic Surgery at Cleveland Clinic, to come up with the idea of using smartphones to enhance communication.


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“I was already calling my cosmetic surgery patients several days after surgery to make sure all was going well,” he says, “but I thought it would be even more helpful to have them send me a picture within two to three days after surgery so I could assess their results visually.” He notes that significant problems after cosmetic surgery are not subtle and can be detected readily on a smartphone “selfie.”

A new protocol is born

From August 2015 to March 2016, Dr. Zins established a postoperative protocol whereby at the time of discharge he sent a text from his Cleveland Clinic smartphone to patients who had undergone cosmetic surgery.

The text instructed them to forward within 48 to 72 hours a postoperative photograph of the area that had been operated on. Once he received the smartphone photograph, he reviewed the image and responded by text or phone call that same day. He enrolled 52 consecutive patients, and 50 of them (96.2 percent) reported on a postoperative survey that the smartphone contact had improved the quality of their care.

“The smartphone photo and dialogue with the patient following review of the photo allowed me to reassure the patient that all was well,” he says. “On the other hand, if a problem was evident, it could be immediately addressed.”

A worthy adjunct to care

Although he had postulated that the protocol would allow him to identify early complications, he was only able to do so in three patients (5.8 percent). In addition, these complications were not identified within the 48- to 72-hour window nor by the time of the postoperative office visit, but rather on subsequent photographs patients were able to send to him.

“Although the protocol didn’t pick up complications before the follow-up visit, it did allow patients to send me pictures one to two weeks later if they were concerned about wound healing,” he says.

Dr. Zins points out that the smartphone photos and texts did not replace the follow-up visit in person, an important distinction from other telemedicine studies. “Research suggests patients do not like to use telemedicine if it replaces an office visit, but this was an adjunct interaction that was able to allay worries until the regularly scheduled postsurgical visit.”

Drawbacks to the protocol are that the photographs sent from the patient’s phone are not confidential and protected under HIPAA rules, and that it creates more work for the physician. “The surgeon could pass off the work to a mid-level provider, but then he or she would lose the power of personal communication between the physician and patient,” he notes. There is also potential for patient abuse of having the surgeon’s professional smartphone number, but Dr. Zins feels the benefits of the protocol outweigh the drawbacks.


“This is a very important issue and points to an opportunity to bring patients and physicians closer together and improve the quality of care,” he concludes.

Results of Dr. Zins’ study will shortly be published in the Aesthetic Surgery Journal.


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