Objective Interpretation of Surgical Outcomes: Is There a Need for Standardizing Digital Images in the Plastic Surgery Literature?

Subjective interpretation of preoperative and postoperative photographs is heavily relied on for evaluating standards of care. For preoperative and postoperative digital images to accurately reflect surgical outcomes, image characteristics, other than acquisition, must be rigidly standardized. The authors investigated, using objective methodology, the consistency of published images within the plastic surgery literature. A panel reviewed four plastic surgery journals (Aesthetic Plastic Surgery, Aesthetic Surgery Journal, Plastic and Reconstructive Surgery, and the British Journal of Plastic Surgery), with 100 consecutive, color, digital, paired preoperative and postoperative images per journal compared. Image characteristics, including color, brightness, contrast, resolution, view, zoom, size, image labeling, background, patient clothing, accessories, makeup/tan, facial expression, and hairstyle, were objectively assessed using a five-point Likert scale; mean values were tabulated and compared among journals; and statistical significance was determined (p < 0.05). The most consistent characteristics among journals included labeling (4.782) and size (4.867), in contrast to clothing (3.097) and hairstyle (3.724) (p < 0.001). Much variability was also present in color, brightness, and view. Plastic and Reconstructive Surgery and American Aesthetic Plastic Surgery were the two most consistent journals when all image characteristics were combined, scoring 4.6 and 4.5, respectively (p