The Importance of an Academic Approach to Patient-Oriented Aesthetic Outcome Research: Reply to Comment on “Validating Facial Aesthetic Surgery Results with the FACE-Q”

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We would like to thank van der Lei and Bouman for their interesting commentary on our recent publication.1 We fully agree with them that patient satisfaction is a complex construct of several factors. Technical success of an aesthetic procedure is certainly only one aspect, and specific psychological preoperative factors might very well affect patient satisfaction after surgery. To gain insight into these effects, it is advisable to also assess the patient’s preoperative data to further understand potential differences in outcome measurements.
This has been strongly emphasized in the Introduction and Discussion sections of our original article and, as we stated there as well, we never intended to promote a specific surgical technique, but were aiming to popularize the FACE-Q as a validated outcome measurement tool, to eventually encourage colleague surgeons to introduce patient-reported outcome measurements into their aesthetic practices.
Additional preoperative psychological measurement tools, as suggested by our colleagues, could add additional relevant information. These measures should assess the patient’s general dissatisfaction with their own appearance and body image, such as the body image dissatisfaction scale. Other individual psychological factors such as self-consciousness might account for differences in patient satisfaction with their surgical outcome and should thus not be missed.
The importance of prospective clinical trials can certainly not be emphasized enough, and only data with a high level of evidence could reliably compare different surgical techniques. In contrast, the number of questionnaires, introduced as a standard routine in an aesthetic private practice, needs to be limited, as a large number of those might lead to malcompliance and low response rates of our patients.
Most importantly, these clinical outcome tools have to be validated like the FACE-Q and, as such, would ideally gain global acceptance among aesthetic surgeons. The realization of such time-consuming research efforts might require an academic aesthetic plastic surgery setting, and we therefore suggest that more specialized professorships for aesthetic plastic surgery might need to be implemented.
In such a clinical outcome research setting, we suggest implementing patient-reported outcome measurements such as the FACE-Q into daily clinical practice to simplify aesthetic outcome assessment, because this will provide important and highly valuable feedback for us surgeons and our patients simultaneously. This is certainly a highly important aspect of aesthetic academic surgery, which has somewhat been neglected in our clinical routine in the past.
We would like to emphasize the potential of implementing the FACE-Q and similar patient-reported outcome measurements as a routine measurement in an academic aesthetic surgical practice preoperatively and postoperatively. We again thank the authors for their valuable comments and suggestions and look forward to continuing the development of aesthetic patient-oriented outcome research in the future also on a multicenter international level.
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