Validating Facial Aesthetic Surgery Results with the FACE-Q

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With great interest, we have read the article by Kappos et al.1 regarding evaluation of a significant number of face-lift patients with the FACE-Q, a validated questionnaire system of patient-reported outcome measurements. We fully agree with the authors that such patient-reported outcome measurements should be integrated into the daily practice of every aesthetic physician to validate his or her clinical outcomes from a patient’s perspective. High patient satisfaction definitely should be reached with cosmetic treatments and surgery.
However, we should be cautious interpreting that higher patient-reported outcome measurement scores means a better surgical technique or clinical result. Although the authors did not explicitly suggest that a face lift with lipofilling is significantly better than a face lift without lipofilling, their presentation may at least suggest it: higher satisfaction rates (higher FACE-Q scores) in the series of face lift with lipofilling and face lift with ancillary procedures may suggest a place for these procedures or combination with ancillary procedures. However, we should realize that higher FACE-Q scores might be because these patients had a significantly worse situation preoperatively (with facial fat atrophy and significantly worse skin quality) than those that did not undergo these ancillary procedures.
Moreover, patient satisfaction is determined not only by the technical success of the surgical procedure but also by various preoperative factors, such as the nature of the appearance flaw, the amount of dissatisfaction, and potentially a disturbed body image (e.g., body dysmorphic disorder). We might therefore argue that the preoperative situation is in part predictive of postoperative satisfaction. Considering the idiosyncratic nature of appearance flaws (i.e., the vast individual differences in facial flaws and dissatisfaction), it might be too early to state that a particular procedure yields more patient satisfaction than an alternative procedure based on the FACE-Q score.
Thus far, no prospective clinical trial has definitely demonstrated the additional effect of lipofilling on the result of a face-lift procedure. Although our clinical judgment as such definitely strongly suggests it, a definite scientific proof has yet to be reported.
In addition to routine evaluation of patient-reported outcome measurements (e.g., FACE-Q), we should also include other evaluations in our aesthetic practice, such as validated assessment scales of certain facial and body features2 and a systematic questionnaire with regard to body image in combination with body satisfaction.3 Only in this way will we be able to improve the outcome of our aesthetic procedures, technically and with regard to patient satisfaction. Moreover, with these tools, we are able to discriminate between those clients that can be helped by just one of our procedures and those who should have psychotherapy because of a disturbed body image (e.g., body dysmorphic disorder) either (1) alone or (2) in combination with the procedure.
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