The vast majority of online breast augmentation reviews in a recent study were positive. But the 12.5% that were negative were characterized as more verbose and only half listed “poor aesthetic outcome” as a driver for dissatisfaction. Negative reviewers often pointed out that they didn’t think surgeons listened, were competent or acknowledged or took responsibility for poor outcomes.
Another surprise? Close to 40% of the negative reviews were written by people who didn’t go through with breast augmentations by the surgeons they reviewed. Rather their impressions of rudeness, curtness and consultation brevity prompted them not only to not proceed with breast augmentation surgery but also to write negative reviews.
A Matter of Why
The study is the first comprehensive analysis of factors that drive online breast augmentation reviews, according to the authors.
In the study, researchers analyzed patient ratings in 1077 breast augmentation reviews on Google, Yelp and RealSelf. Reviews were from the metropolitan areas of New York, Los Angeles, Chicago, Houston, Philadelphia and Miami.
Having a better understanding of why patients write positive and negative reviews is important, given that online reviews are growing in popularity and are powerful ways in which today’s consumers do or do not recommend surgeons. One-third of Americans indicate they are greatly affected by online reviews, and nearly 60% think of online reviews as at least somewhat important, the authors report.
The online review trend is expected to intensify. Online reviews for breast augmentation alone have grown an average 42.6% annually from 2011 to 2016, according to the study.
Anatomy of a Positive Review
More than 87% of the reviews studied were positive, which the authors defined as four or five stars on Google and Yelp, or a Worth It rating on RealSelf.
The top five most cited reasons for patient satisfaction among the 935 positive breast augmentation reviews were:
• A good aesthetic outcome (643)
• A good bedside manner (573)
• A friendly and/or helpful office staff (520)
• The surgeon’s expertise (405)
• Provider listens to patient (332)
Reasonable cost was the least likely reason for patient satisfaction in the study.
And unlike the negative reviewers, all of the positive reviewers had breast augmentations with the surgeons they reviewed.
Dissecting Negative Reviews
Researchers defined negative reviews as a one- or two-star rating on Google and Yelp or a Not Worth It rating on RealSelf. The top five reasons among the 142 negative reviews:
• Poor aesthetic outcomes (71)
• Provider doesn’t listen to the patient (57)
• Lack of competency (50)
• No acknowledgment/responsibility for a poor outcome (47)
• Cost too high (40)
Asymmetry and implant malposition were the most common factors associated with poor aesthetic outcomes. But the researchers also report seeing recurring disagreement between surgeons’ and patients’ perceived outcomes, where surgeons were happy with the work but patients weren’t.
This discordance between how patients versus physicians perceive aesthetic outcomes has been demonstrated in the literature. By misinterpreting aesthetic outcomes patients might be more likely to think surgeons aren’t taking responsibility or not listening, the authors write.
We Can Overcome
In a secondary analysis, researchers found aesthetic outcome, surgeons’ perceived skills and surgeons’ attentiveness had the most impact on patient satisfaction.
“… reviewers often expressed the sentiment that even though they encountered negative experiences, they ultimately left a positive review because they liked their aesthetic result,” according to the authors.
When they looked at whether a poor aesthetic outcome could lead to a positive review, chances were slim but it was possible. Less than 6% of reviews that mentioned a poor aesthetic result were positive. Further analysis revealed that these patients left positive reviews because they had realistic expectations that their outcomes could be poor. And because of surgeons’ proactive follow-up, they were able to overcome a poor outcome in their reviews.
In the end, a good aesthetic outcome remains critical to and protective of a surgeon’s online rating, even if the patient had positive and negative experiences with a practice, the authors write.
Tips for Better Communication
David B. Sarwer, Ph.D., author of an accompanying editorial and associate dean for research in the College of Public Health at Temple University, writes that, in several respects, negative reviews are more informative than positive reviews to plastic surgeons and their practice staffs.
“Analysis of negative comments suggests a couple of areas that even high-functioning, successful practices should target in an effort to further improve overall patient experience and to minimize undesired patient experiences,” according to Dr. Sarwer, who has been studying the psychosocial aspects of cosmetic surgery for more than 20 years.
One observation Dr. Sarwer says he has made as a psychologist working with plastic surgery patients pre- and post-surgery is that most patients minimize the risk of undesired outcomes.
There are things surgeons and patients should communicate effectively to avoid misunderstandings, unrealistic expectations and more.
“… I think that new patients should be able to articulate and cosmetic surgeons understand three fundamental issues,” Dr. Sarwer writes in an email to The Aesthetic Channel.
1. “Patients should be able to describe their concerns about their appearance specifically and in a manner where the surgeon can both see the feature of concern and understand why it is of concern,” according to Dr. Sarwer.
It’s more useful, for example, for a patient to say, “I don't like how my crow’s feet make me look older than I am,” and for the surgeon to be able to see those wrinkles, than for a patient to say, “I look old,” leaving the surgeon to guess what feature is of greatest concern.
2. “Patients should understand and be prepared to explain their motivations for a given procedure,” Dr. Sarwer writes. “They should want a procedure to not only improve their outward appearance, but also improve their body image and self-esteem. Patients who are motivated by external factors, such as perceived pressure from a current or future romantic partner, may be setting themselves up for disappointment.”
3. “Patients should have realistic expectations of the impact of the procedure on their daily lives,” he writes. “While some surgical procedures can be quite noticeable to others, many of the minimally invasive procedures may not be noticed by others. Patients should not be disappointed if others do not notice the change in appearance and should remind themselves that the procedures are designed to improve their body image and self-esteem. The procedures may not impact social interactions with others.”
