Introduction. - La presse se fait l'écho d'insatisfactions, sinon de « ratages », dont l'appréciation est difficile. Les études disponibles présentent des biais majeurs (nombre de patients/indépendance des auteurs). Confrontés à des patients plus ou moins satisfaits de leur intervention, nous proposons une contribution sous forme d'une enquête (analyse quantitative) et d'une analyse (qualitative) de dossiers.

Matériel et méthode. - Questionnaires d'enquête disponibles sur Internet (quantitatif)/analyse de 50 dossiers de patients insatisfaits (qualitatif).

Résultats. - Quatre cent quatre-vingt-une réponses - femmes 89,6 %/hommes 10,4 %. Information insuffisante dans 31 %. Indices de satisfaction : très bien/bien = 62 % ; moyen/ peu satisfaisant/raté = 38 %. Ne referait pas l'intervention = 18,5 %. Ne conseillera pas l'intervention = 23,3 %. Analyse qualitative des dossiers = 82 % de dépressions et 12 % de dysmorphopathies/50 cas (100 %) de défaut d'information « ressenti ».

Discussion. - Les indices de satisfaction « très bien » et « bien » ne totalisent que 62 % des réponses, ce qui tranche avec les statistiques habituelles (90 à 95 %) émanant des praticiens. Analyse qualitative : la prévalence des troubles psychiques après intervention insatisfaisante est élevée. Si la demande esthétique est bien d'ordre psychologique, l'acte chirurgical devrait s'inscrire dans une prise en charge plus globale du patient.

Conclusion. - La responsabilité du praticien entraîne des obligations concernant la qualité de l'indication, de l'information, de la compétence technique et du suivi du patient. Les leviers d'amélioration semblent concerner en priorité la sélection des patients et la qualité de la communication.

Introduction. - Plastic surgery operations have considerably increased in the past 20 years. The media more and more often reflect dissatisfactions, if not outright “failures”, which are very difficult to quantify. The few available studies suffer from significant defects (number of patients/authors' independence). Since 1991 we have taken note of various levels of dissatisfaction among members of the AIME association with regard to their plastic surgery operations. We offer a contribution in the shape of a survey (quantitative) and an analysis (qualitative) of patients' records.

Material and method. - Survey questionnaire available on the internet site INFOESTH.com (quantitative) and analysis of 50 dissatisfied patients' records received at the association (qualitative).

Results. - The quantitative survey analysed 481 answers of which 431 from women (89.6%) and 50 from men (10.4%). Information was considered insufficient in 152 of the cases (31.8%). Satisfaction rating after the operation: very good = 190 cases (39.5%)/good = 110 cases (22.8%)/average = 60 cases (12.4%)/not very satisfactory = 53 cases (11%)/failed = 68 cases (14.1%). Would not undergo another operation = 89 cases. Will not recommend the operation to a friend = 112 (23.3%). Qualitative analysis (records): 41 depressive cases (82%) and six dysmorphopathy cases (12%)/50 cases complaining of a lack of information. Patients complain about the denials of their practitioner and a lack of medical follow-up resulting in blocked communications, which do not encourage them to undergo a retouch operation.

Discussion. - Despite recent efforts to improve information, it is still believed to be inadequate in 31% of cases in the survey and 100% of the cases on file. Satisfaction ratings “very good” and “good” only add up to 62% of answers in the survey, which contrasts strongly with the usual statistics (90-95%) issued by practitioners. Qualitative analysis of patient files: the prevalence of psychic distress after an unsatisfying operation is high, although it is not possible with depression to distinguish between pre-existing and reactional pathology. If one considers that the aesthetic expectation is mostly psychological, the plastic surgery act should only be one of the aspects of a more global care of the patient. Otherwise, patients think they “buy” a result rather than an attempt at getting results.

Conclusion. - The responsibility of the surgeon brings with it obligations concerning the quality of his recommendations, of the patient information, of the surgeon's technical skills and of the patient's follow-up. The results of this investigation show that the improvement “tools” seem to be first of all the patients' selection and the quality of communication.