Refinement of Lower Blepharoplasty --Introducing Service Quality Management System to Plastic Surgery Gerry Tzyy-Jiin Chen, M.D.

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Refinement of Lower Blepharoplasty --Introducing Service Quality Management System to Plastic Surgery Gerry Tzyy-Jiin Chen, M.D. 1,2,3 Hui-Chu, Lang, M.D., PhD 3, Chen-Yao, Su D.D.S. 4, PhD.,Hsu Ma, M.D., PhD. 2,3 1. La Visage Beauty Center, La Visage Biotech Management Consultant Company La Visage Group 2. Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital Nothing to disclose 3. School of Medicine, National Yang-Ming University 4. School of Dentistry, National Yang-Ming University 2014 Annual Meeting of American Society of Plastic Surgeon, Chicago

The Best Medical Service Quality Reach the demand of customers The key point can be divided to 3 aspects Personnel service procedure Professional technique Environment Persistent refinement can be done with management system by customer satisfaction questionnaire analysis and systemic check.

La Visage Group Proved series of certification International Standardization for Organization 9001 Management system TUV Service Quality Management System National Accredit for Aesthetic Surgery and Treatment by Taiwan Joint Commission on Hospital Accreditation

La Vsage Group La Visage Biotech Management Consultant Company provides medical management consultation service and biotech( stem cell, PRP, surgical wound management)research product. La Visage Beauty Center provides service of aesthetic surgery and treatment.

The Central Concept and Advantage of La Visage Group Love Passion Honesty 5S Concept Empathy, Feeling of customer SOP Prospective Service Health Safe Indivisualized SOP Public Welfare Speaking, Writing and Doing are the Same ISO Frame Achieveme nts Inspection, Bonus System New Idea of Medical Service Quality Etiquette Training Customer Complaints Management Management by Objectives

Objective of Study To Make Sure the Effect of Service Quality System on Refinement of lower blepharoplasty Operation result satisfaction questionnaire survey of customers (n=26) receiving lower blepharoplasty (2013/2 to 2013/4). Good orbicularis muscle curvature. Complain about persistent tear trough deformity(31%)and lower eyelid soft tissue insufficiency after surgery (35%), both (15%).

The Cause of Tear Trough Volume loss Orbital fat herniation Skin laxity Plast. Reconstr. Surg. 125: 699, 2010.

Methods Refined Preoperative Preparation by Service Quality System Check Communication Operative equipment Planning and 1 and materials preparation 2 3 Designing Anesthesia Aseptic and 4 PPP,PRP drapping 5 6

Methods Refined Surgical Technique Wound creation Undermining Medial muscle Dissection Fat excision release if needed 1 3 4 2 Check adequate fat excision 5 Fat Transplantation 6 Orbicularis m. PRP, PPP Fat Reposition 7 suspension 8 wound closure 9 Postoperative Care & Follow Up Regular follow up for operative results, Post OP 3rd/7th/14th day, 1st/2nd/3rd/6th month

Materials-- Customer Population 2013/10-2013/12, 20 cases, mean skin excision 3.15mm Average 50.9 y/o Fat transplant 18 (90%) 6(30%) M release 8 (40%) 1(5%) fat transposition 2 (10%)

Results Customer General Service Satisfaction Questionnaire survey first follow up after operation 10 9.5 9 8.5 8 7.5 7 2013/2-2013/4 1 2 3 4 5 6 7 8 9 10 10 9.5 9 8.5 8 7.5 7 2013/10-2013/12 1 2 3 4 5 6 7 8 9 10 Significant findings: improvement of environment cleaning(1), air conditioning(2), procedure moving line(6), perioperative communication with medical staffs and doctor(7-9) and privacy(10). (single tail t test, α=0.1)

Results Customer Operation Result Satisfaction Operation result satisfaction questionnaire after 3 months, satisfaction scale from 0 to 10 degree Questionnaire Average 8.29+ 0.70 (2013/2-2013/4,n=7) 9.16+SD 0.75 (2013/10-2013/10, n=6) Cumulative analysis may needed.

Results--Complication Uneven 3 (15%) treated by conservative treatment Soft tissue insufficiency 1 (5%) treated by filler Redundant skin 1 (5%) treated by laser resurfacing Transient ectropion 4 (20%) treated by conservative treatment All complications were finally recovered.

Conclusions Combined ISO 9001 and TUV service quality management system may help optimizing procedure detail to reach the best customer satisfaction. Meticulous whole professional procedure preparation is the key factor of medical service quality. Fat transplantation is almost basic for soft tissue supplement for lower blepharoplasty. Periorbital structure reposition may help the result of lower blephaoplasty.