The Objective Eye: An Oxymoron?

Extract

Things are, for each person, the way he perceives them.

-Plato, 427 to 347 BC

I am always intrigued by topics in aesthetic surgery that blur the lines between medicine, social science, physics, and philosophy. That is one reason I found the article “Apparent Age is a Reliable Assessment Tool in 20 Facelift Patients” so fascinating.¹ Frautschi et al have done an excellent job in designing a study to meet the needs of aesthetic surgeons and patients for outcome measures that go beyond self-reported patient satisfaction surveys. They also are thorough and transparent in pointing out their study’s limitations, some of which might well be considered unavoidable. Pure objectivity should always be the scientist’s goal but, particularly with regard to visual assessments, may be an ideal that is unattainable.

The stated purpose of the study was to examine whether a visual estimate of age by objective observers represents a reliable and valid measure for evaluation of facelift outcomes. Ten blinded reviewers, at several 3-month intervals, assessed randomly ordered photographs of 20 pre- and postoperative facelift patients, assigning an estimate of age based on each photograph. Frautschi et al found that the value of apparent age (AA) assessment produced from a single reviewer could not be considered a reliable/highly reproducible outcome measure but that group data produced good reliability. At the same time, the study raises provocative questions about how our inherent subjectivity impacts the question of objective scientific knowledge.