TY - JOUR
AU - Oppikofer, Claude
AB - The risks of online survey tools have been recognized from their early days; 1 and even SurveyMonkey warns about inherent bias.2 The problem is that collecting data—and a lot of data!—is easy, but it is difficult to draw scientific conclusions out of these data. The limitations of this study3 are mentioned in the Discussion section, and it is good that the authors have recognized and admitted them. But a response rate of 11.3%, even if “generally comparable to the participation obtained in such surveys,” is an important limitation—because we are not looking at a random sample, but a self-selected sample with important biases. The total number of Brazilian butt lift (BBL) procedures performed by the respondents during their careers is indicated to be 203,629. This number seems to come from adding all entries in item #3 of the questionnaire (“How many buttock fat grafting procedures have you performed?”). Let us consider for ourselves how we answer such a question when we take a few minutes to fill out a SurveyMonkey poll. Only a few of us will look up the precise number in our surgery statistics. We are much more likely to give an estimated number (which furthermore is probably much higher than the reality). These uncertainties can add up to a huge span, and it may be more appropriate to indicate the result as “between 100,000 and 250,000” rather than stating a precise number. The same is true for the number of BBL procedures performed in the last 24 months, which provides the basis for the calculated mortality and pulmonary fat embolism rates. Moreover, 203,629 career cases reported by 572 respondents equates to an average of 357 cases per surgeon; and if we consider the 79.7% who actually perform BBLs (455 respondents), the average number per surgeon would be 448 cases. This is a surprisingly big difference compared with the median value of 30, and this discrepancy therefore deserves to be critically questioned and discussed. The main problem of the selected samples in 20174 and 2019, however, is the fact that it is difficult to determine if they represent a comparable group within the community of plastic surgeons. Assuming that similar numbers of lifetime cases, geographic distribution, and volume of injected fat may indicate that both surveys “are sampling the same group and likely represent random sampling to allow direct comparison” may be useful for the purpose of reaching the expected conclusions. But it is not proven. There is a considerable risk that the sample in the 2019 survey is biased by containing a high proportion of surgeons who changed their attitude after the 2017 recommendations and are keen to prove it; this therefore suggests that most conclusions drawn from the authors’ Table 4 are not completely reliable and hence should not be overinterpreted. When limitations reach such high levels as are found here, they must lead authors not only to mention and discuss them but to temper certain conclusions. Nevertheless, the study is interesting and does contain data that deserve to be looked at closely and can even be used to draw scientifically relevant conclusions. I refer to the questions inquiring about changes in attitude among the responding group of surgeons. Because here we are looking at the same group of surgeons and have no need to try to compare apples to oranges. Items 9, 11, 13, 16, 18, 23, and 26 document positive changes in attitudes since the guidelines were published. It would have been interesting to add a table demonstrating only the results of the aforementioned items as established by the 2019 survey. In summary, despite the concerns I have raised, the study shows encouraging results. It is interesting and valuable where it documents positive changes in attitudes of at least a small group of surgeons after the publication of the recommendations of the Task Force. This underlines the importance of establishing such guidelines and educating surgeons about safety issues. However, other conclusions of the study—such as the improvement in the mortality rate and the claim that BBL has reached a level of acceptable safety—may not be scientifically proven because of the small sample size and the multitude of other biases. Nevertheless, the study can be seen as positively “hypothesis-generating, rather than conclusive” 5 and, as the authors suggest, encourages the establishment of rigorous evidence-based research. For this, they have to be congratulated for their contribution. Disclosures The author declared no potential conflicts of interest with respect to the research, authorship, and publication of this article. Funding The author received no financial support for the research, authorship, and publication of this article. REFERENCES 1. Waclawski E . How I use it: Survey Monkey . Occup Med (Lond). 2012 ; 62 ( 6 ): 477 . Google Scholar Crossref Search ADS PubMed WorldCat 2. Leading types of bias in research and how to prevent them from impacting your survey. https://www.surveymonkey.com/mp/dont-let-opinions-sneak-survey-4-ways-avoid-researcher-bias. Accessed April 17, 2020 . 3. Rios L , Gupta V. Improvement in Brazilian butt lift (BBL) safety with the current recommendations from ASERF, ASAPS, and ISAPS . Aesthet Surg J. 2020 ; 40 ( 8 ): 864 - 870 . OpenURL Placeholder Text WorldCat 4. Mofid MM , Teitelbaum S, Suissa D, et al. Report on mortality from gluteal fat grafting: recommendations from the ASERF task force . Aesthet Surg J. 2017 ; 37 ( 7 ): 796 - 806 . Google Scholar Crossref Search ADS PubMed WorldCat 5. Minimizing mistakes and embracing uncertainty . PLoS Med. 2005 ; 2 ( 8 ): e272 . Crossref Search ADS PubMed WorldCat Author notes Dr Oppikofer is a plastic surgeon in private practice in Montreux, Switzerland. © 2020 The Aesthetic Society. Reprints and permission: journals.permissions@oup.com This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)
TI - Commentary on: Improvement in Brazilian Butt Lift (BBL) Safety With the Current Recommendations From ASERF, ASAPS, and ISAPS
JF - Aesthetic Surgery Journal
DO - 10.1093/asj/sjaa110
DA - 2020-07-13
UR - https://www.deepdyve.com/lp/oxford-university-press/commentary-on-improvement-in-brazilian-butt-lift-bbl-safety-with-the-mxlSnRtcSi
SP - 874
EP - 875
VL - 40
IS - 8
DP - DeepDyve
ER -