Joris van Dongen

188 Chapter 8 Photographic evaluation Scar appearance was assessed using photographic evaluation of postoperative photographs 6 months and 12 months after surgery. All photographs were digitally taken and white balanced using a color chart withAdobe LightroomCCVersion 4.0. All photographs were cropped to only display the lateral five cmof the horizontal scar using Adobe Photoshop CC Version 19.1.9. Photographs were randomly divided into three online surveys using SurveyMonkey (SurveyMonkey, Palo Alto, CA). Three observer groups of three plastic surgeons rated each blinded photograph of one survey from 1 – 10 on a visual analogue scale (VAS). In total, three surveys containing postoperative photographs were analyzed. After at least 72 hours, the same survey in a random sequence was scored again to determine the inter- and intra-observer agreement. Statistical Analysis Statistical analysis was performed by an independent statistician (KMV) that received blinded data from the first author (JAD). Apaired samples t -test was used to analyze the outcomes of the POSAS questionnaire. A two-sided p<0.05 was considered statistically significant. Inter- and intra-observer agreements were determined based on a weighted kappa coefficient in SPSS. 21 All analysis and designing of the graphs was done with the use of prism 8 (GraphPad software, La Jolla, CA, USA). RESULTS Demographics Atotal of thirty-four subjectswere enrolled in this study. Six subjectswere lost to follow- up before the first postoperative visit and three subjects did not complete the entire study. All subjects lost to follow-up did not specify reasons and were compensated by including six additional subjects. Mean age of subjects was 40 ± 13 years old. No complications related to tSVF injections occurred.