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Lessons From Unfavorable Online Reviews of Minimally and Noninvasive Cosmetic Procedures

Jacqueline D. Watchmaker, MD, Boston University School of Medicine, Boston, Massachusetts
Disclosures: None.


Jacqueline Watchmaker, MD

Introduction
The frequency of minimally and noninvasive cosmetic procedures performed in the United States is increasing; however, there have been few studies looking at patient-reported subjective outcomes of these procedures. Our study gathered data from RealSelf.com (Seattle, Washington), an online patient-driven review website, to determine the most common reasons patients are dissatisfied with cosmetic treatments.


Methods
Between June 2019 and July 2019, the authors extracted patient-reported outcome data from RealSelf.com for the following treatments: Coolsculpting, Ultherapy, Kybella injections, miraDry, Thermage, Cellfina, Emsculpt, and thread-lifts. On the RealSelf website, patients are able to rate their aesthetic procedure as “worth it”, “not sure” or “not worth it”; only data from “not worth it” reviews were extracted for this study. In total, there were 1359 reviews. Reviews from outside the United States were excluded. If a patient listed 2 reasons for dissatisfaction (eg, complication and ineffective treatment) both reasons were recorded. Specific complications and postoperative time frame of review, when listed, were recorded.

Results
In total, 1204 reviews were included in the analysis. The most frequent reason for patient dissatisfaction was ineffectiveness for Coolsculpting (n=427, 82.9%), Ultherapy (n=120, 67.8%), Kybella (n=55, 75.3%), miraDry (n=40, 85.1%), Thermage (n=81, 61.4%), Cellfina (n=18, 78.3%), and Emsculpt (n=5, 100%), with complications listed as the second most common reason for discontent. For thread-lifts, however, the most common reason for a “not worth it” rating was a complication (n=43, 70.5%) followed by perceived ineffectiveness (n=36, 59%). Severe pain during and/or after the procedure was the most common patient-reported complication for Coolsculpting (n=62, 37.3%) and thread-lifts (n=10, 23.3%). Perceived fat loss was the most common side effect for Ultherapy (n=32, 38.6%) and Thermage (n=26, 40%), with swelling, numbness, new-onset “lumps,” and flatter buttock muscles as the most common patient-reported complications for Kybella (n=9, 40.9%), miraDry (n=6, 27.3%), Cellfina (n=6, 46.2%), and Emsculpt (n=1, 100%).

Discussion
Our study shows that perceived ineffectiveness and complications were the most common reasons for dissatisfaction of the minimally and noninvasive cosmetic procedures analyzed. Knowing the most common patient-reported complaints of a given procedure can help physicians counsel and educate patients prior to a procedure. Many of the patient-reported complications found in this study are known and unfortunate true potential complications; it is important to note, however, that many dissatisfied patients listed an expected side effect such as pain, bruising, or swelling, rather than a true complication as their reason for discontent. More thorough preprocedure education may help patients differentiate between a true complication and a transient and expected side effect that in turn may improve patient satisfaction. In the modern era of social media and online reviews, a positive patient perspective on an aesthetic treatment is increasingly important. Patient dissatisfaction due to true complications and ineffective treatment cannot be completely prevented; however, by learning from the negative patient-reported outcomes as detailed in this study, physicians can work toward improving the patient experience.

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