Usually only one or two photos are needed for the plastic surgeon James Zins, MDto assess a patient’s progress in the first days after facial cosmetic surgery.
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“Most problems after surgery are 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 the Cleveland Clinic, has instructed patients to send him digital photos of their surgical site after outpatient surgery. It’s an additional point of contact meant to complement — not replace — in-person follow-up appointments.
“Many patients, especially those who have not had facial cosmetic surgery before, are surprised by the swelling and bruising that usually occurs,” she says. “It can be worrying for them. Looking at it and reassuring them that it’s normal – or taking care of urgent issues quickly – helps improve their experience and satisfaction afterwards.”
What Dr. Zins is now confirmed in a study published in the Journal of Cosmetic Surgery.
“We designed the study to find out two things: whether the procedure improved the patient experience and whether it increased the early detection of complications after surgery,” says Dr. Zins.
About the study
From August 2015 to March 2016, Dr. Jeans texted 57 patients during discharge after cosmetic surgery. In the text, directly from the surgeon’s hospital-authorized and secure smartphone, patients were instructed to respond within 48 to 72 hours with photos of their surgical site. When the photos arrived, Dr. Zins viewed them and contacted patients via voice or text to discuss the findings.
Of the 57 patients, 52 answered a questionnaire about the procedure. Of the 52 respondents, 50 (96.2%) reported that the procedure improved their postoperative experience. Of the 41 respondents who had previous cosmetic surgery, all 41 (100%) stated that their post-surgery experience this time was more satisfactory than their previous experience.
Three patients (5.8%) had complications detected by Dr. Zins on a smartphone photo. However, all three occurred after the patient’s in-person follow-up visit (usually five to seven days after surgery).
“We were hoping to see an increase in early detection,” says Dr. Zins. “But these complications were not apparent for the first 48-72 hours. However, patients used the same process – sending a photo to my smartphone – to quickly draw attention to issues that arose later, usually seven to 11 days after surgery.”
Regardless of the time frame, the digital photos taken of patients were of sufficient quality to show details that alerted Dr. Zins that urgent care was needed.
Risk management
This procedure, while valuable to patients, carries risks, including:
- Patient privacy and safety. All patients participating in the smartphone-based program signed a release form, allowing their photographs to be used for medical evaluation. A disclaimer in the original text message from Dr. Zins showed that photos taken, stored and sent on patient smartphones cannot be considered secure or HIPAA compliant. Dr. Zins transferred photos from his secure, hospital-approved smartphone to a HIPAA-compliant medical imaging system and then deleted them from his phone to protect patient privacy.
- Abuse of surgeon accessibility. Zins welcomed patients to contact him at any time during their postoperative course, not limited to the first 72 hours. “Yes, more patients now have direct access to my personal phone number,” says Dr. Zins. “There is a potential for overuse. But for the most part, I haven’t experienced that with my patients. The benefit of smartphone communication outweighs the potential drawbacks.”
- Added responsibility for the surgeon. “This step creates a little extra work for the surgeons because it’s in addition to the standard personal monitoring,” says Dr. Zins. “I handled these communications personally, but other surgeons may prefer to delegate them to nurses or advanced physician providers.”
The next step in this research will involve studying the benefits of smartphone photography over longer follow-up periods.
“I suspect we can prevent some emergency visits in the long run,” says Dr. Zins. “Before we relied on smartphone photos, patients calling to report swelling or bleeding would be sent to an emergency department. Now we may be able to manage these cases differently.”
Dr. Zins encourages more plastic surgeons to consider using this form of virtual early monitoring.
“Telemedicine can be particularly useful in medical specialties where visual assessment is important,” says Dr. Zins. “Cosmetic surgery is definitely one of them.”
Note: Photo used with permission of the publisher. Originally published as: Pozza ED, D’Souza GF, DeLeonibus A, Fabiniani B, Gharb BB, ZSins JE. Patient satisfaction with a timely smartphone-based cosmetic surgery postoperative follow-up. Aesthetic Surg J. 2018? 38 (1): 101-109.
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