Recherche évaluative en chirurgie esthétique maxillofaciale

Both clinical research and evaluation research focus on the therapeutic outcomes. But unlike clinical research, evaluation research examines such results from the patient's perspective, the criteria being what the patient feels rather than physical or laboratory data. Such research is of utmost importance in aesthetic surgery since the real benefit is subjective rather than functional. Evaluation research provides some solution to the ethic problem of the risk: benefit ratio of aesthetic surgery. Parallel with its improvements, its indications are being better identified. In this type of research, the evaluation tools may be a satisfaction index, a quality of life rating scale, or a psychological rating scale. Satisfaction indexes are easy to use but there have a related limitation since responses may be easily inferred. They are obtained using visual analogue scales comparable to those used for pain assessment. Quality of life tests combine in a single composite score many dimensions such as physical, social, psychological and emotional criteria. Quality of life tests may be generic or specific. Specific tests take into account the disease or the patient's care-seeking, i.e. his (her) need for aesthetic surgery. Generic tests provide an overall quantification of the patient's quality of life regardless of the care-seeking dimension, and with a lesser risk of bias. Finally, psychological rating scales are naturally the most frequently used due to the psychological aspect related to the need for aesthetic surgery. They investigate depression, anxiety, bodily image, etc. A literature review shows that maxillofacial aesthetic surgery does not improve depression indexes but it clearly improves self-confidence, self-esteem and bodily image. Aesthetic surgery improves the results of generic or specific quality of life tests when they include some of the above-mentioned psychological parameters.