Measuring Stakeholder Assessments of Postsurgical Facial Scars: A Retrospective Cohort Inter-rater Analysis of Patients, Physicians, and Medical Student Observers

Abstract

Background: The relationship of postoperative facial scar assessments among patients, physicians, and societal onlookers is not clearly defined.

Objective: To identify differences in perceived scar outcomes by different stakeholders.

Methods and materials: Retrospective cohort study at a single Mohs micrographic surgery (MMS) center during which scars were assessed by: patients, physicians, and medical student observers not involved in patients' care using the Patient and Observer Scar Assessment Scale (v.2). Eighty-one patients graded their scars at 2 visits: 1 to 2 weeks post-MMS and 3 months post-MMS. Deidentified patient photographs were taken at each visit and graded by 4 physicians and 12 observers.

Results: At week 1, there was a significant difference in overall opinion of scar appearance between patient and physicians (p = .001) and medical student observers and physicians (p < .001). Physicians graded scars more favorably. At 3 months, there remained a difference in scar evaluations between patient and physicians (p = .005), whereas medical student observers rated scars more similarly to physicians (p = .404).

Conclusion: Postoperative scar perceptions differ among stakeholders. Physicians must be mindful of this disparity when counseling patients in the perioperative setting to align patient expectations with realistic scar outcomes.