Does Tumescent Infiltration Have a Deleterious Effect on Undermined Skin Flaps?

Abstract

An objective grading system for the evaluation of cosmetic surgical results is presented. The ideal result for the specific procedure is the standard against which the surgical result is evaluated. This is based on the concept that perfection is the lack of imperfection. The result is graded based on identification of imperfections or flaws that deviate from the ideal. All potential flaws can be classified under one of five possible flaw categories: malposition, distortion, asymmetry, contour deformity, and scar. Each flaw category is graded for severity: perfect, noticeable, obvious, and obvious and deforming. Each severity level is assigned a value: perfect, 0 points; noticeable, 1 point; obvious, 5 points; and obvious and deforming, 15 points. The total points under the flaw categories are added for the total score. A perfect result has 0 flaws and gets a score of 0. Scores of 1 to 4 are good results, 5 to 14 are mediocre, and 15 or greater are poor. The benefits of this grading system include the easy identification of deficiencies and result in easy implementation of a plan to eliminate the flaw in the future. It increases the critical observational acumen of the surgeon. It helps in the evaluation of the surgical procedure as it relates to the end result. It improves the result and it improves our ability to communicate results within our profession in a meaningful way.