Assessing Improvement of Facial Appearance and Quality of Life after Minimally-Invasive Cosmetic Dermatology Procedures Using the FACE-Q Scales

January 2016 | Volume 15 | Issue 1 | Original Article | 62 | Copyright © January 2016

Brian P. Hibler BS, Jonathan Schwitzer MD, and Anthony M. Rossi MD

Memorial Sloan Kettering Cancer Center New York, NY

BACKGROUND: Detecting clinically meaningful change from the patients' perspective is critical to evaluating a successful cosmetic procedure. FACE-Q is a patient-reported outcome instrument for use in patients undergoing cosmetic procedures.
OBJECTIVE: We sought to determine the impact of laser resurfacing and injectable treatment (neurotoxin or fillers) on patient perceived improvement in facial appearance.
METHODS and MATERIALS: Patients were asked to complete FACE-Q scales (Satisfaction with Facial Appearance, Satisfaction with Facial Skin, and Appraisal of Facial Lines) at their pre-procedure consultation and/or at post-procedural follow-up. Item means (range 1-4) and Rasch transformed scores (range 0-100) were compared pre to post-procedure using two sample t-tests. Higher FACE-Q scores indicated greater satisfaction.
RESULTS: Overall, patients experienced a statistically significant improvement in all three scales pre- to post-procedure (P <0.05). Sub-group analysis showed statistically significant improvement in Satisfaction with Facial Appearance and Satisfaction with Facial Skin for both the laser resurfacing group and injectables group with moderate effect sizes. Improvement on Appraisal of Facial Lines trended toward improvement but did not reach statistical significance.
CONCLUSION: Our results support the ability to directly measure and quantify meaningful improvement in appearance among facial cosmetic dermatology patients using FACE-Q scales. Reporting this data is important, as this is the first step towards evidence-based cosmetic procedures in dermatology.

J Drugs Dermatol. 2016;15(1):62-67.


The demand for cosmetic dermatologic procedures is continuing to increase. In a 2013 survey conducted by the American Society for Dermatologic Surgery, the top cosmetic procedures performed were laser/light/energy-based, wrinkle-relaxing injections, and soft-tissue fillers.1 Compared to data from 2012, the number of these procedures was up 34%, 20%, and 8.6%, respectively.1 With advances being made in laser technology, botulinum toxin, and injectable fillers, dermatologists are better able to refine and customize their treatments to best meet the needs of individual patients.
A main outcome of a successful cosmetic dermatologic procedure is patient satisfaction. The ability to detect clinically meaningful change from the perspective of the patient is critical to evaluating satisfaction levels. Furthermore, both patients and physicians may desire a metric from which they can ascertain expected outcomes. As a result, health related quality of life (QOL) based assessments are critical to objectively demonstrate the impact and efficacy of cosmetic dermatology procedures.
A recent systematic review of the literature found that psychosocial QOL factors improve after facial cosmetic procedures; however, this evidence is limited.2 The lack of data regarding outcomes on psychosocial functioning after minimally invasive facial procedures underscores the importance for better metrics to assess outcomes and the need for additional studies in this field.
A number of patient-reported outcome (PRO) instruments have been developed to measure a range of outcomes related to cosmetic procedures; however, a review by Kosowski et al in 2008 found all PRO assessments at that time had limitations in their development, validation, or content.3 In response, a comprehensive set of scales used to measure outcomes in facial aesthetic patients was developed to fill this void of reliable and valid PRO instruments, named the FACE-Q.4
The conceptual framework for the FACE-Q scales was developed based on an extensive literature review, patient interviews, and input from an expert panel of physicians.4 Separate scales were developed to measure outcomes for patients undergoing any type of surgical and/or non-surgical facial cosmetic procedure. The scales can be independently scored with pre-procedure and post-procedure versions. The initial development and validation