Subscribe to RSS
DOI: 10.1055/s-0037-1606637
Measuring Patient-Reported Outcomes in Rhinoplasty Using the FACE-Q: A Single Site Study
Publication History
Publication Date:
29 September 2017 (online)
![](https://www.thieme-connect.de/media/fps/201705/lookinside/thumbnails/10-1055-s-0037-1606637_170064oa-1.jpg)
Abstract
Rhinoplasty is one of the most popular surgical cosmetic treatments. Measuring the appearance of the nose has typically involved the use of observer- or surgeon-reported outcome measures (e.g., photographs). While objective outcomes are important, facial appearance is subjective, and therefore outcome assessment should incorporate the patient perspective through the use of patient-reported outcome measures. This study aims to explore relationships between FACE-Q scales scores and measuring adverse effects and change 4 months after surgery in a United Kingdom sample. A questionnaire booklet was completed by patients seeking rhinoplasty between March 2014 and March 2015. The study was conducted at a facial plastic surgery clinic office in London, United Kingdom. Pre- and postoperative rhinoplasty patients aged 19 years and older participated in the study. FACE-Q scales/checklist was utilized for the study. A total of 54 preoperative patients completed seven FACE-Q scales. Before surgery, characteristics of the nose that our sample at least satisfied (i.e., at the harder end of the clinical hierarchy) included the tip of the nose, and how the nose looked in photos and from different angles. In preoperative participants, lower scores for satisfaction with nose and/or nostrils correlated with lower satisfaction with facial appearance and appearance-related psychosocial distress. Participants (N = 13) who had surgery reported significant improvement in satisfaction with the nose, nostrils, and facial appearance overall, and improved psychological and social function. Standardized response means ranged from 0.65 (social function) to 1.55 (facial appearance). The FACE-Q rhinoplasty module can be used in clinical practice, research, and quality improvement to incorporate the patient perspective of appearance in outcome assessments. The level of evidence is defined as level III (diagnostic).
Contributions
Anne Klassen and Andrea Pusic conceived and designed the study. Anne Klassen, Lydia Badia, Charles East, and Dan Marsh participated in collection and assembly of London data. Anne Klassen and Andrea Pusic participated in data analysis.
Financial Disclosures
The FACE-Q is owned by the Memorial Sloan-Kettering Cancer Center. Anne Klassen and Andrea Pusic are codevelopers of the FACE-Q and, as such, receive a share of any license revenues based on Memorial Sloan-Kettering Cancer Center's inventor sharing policy.
-
References
- 1 British Association of Aesthetic Plastic Surgeons. BAAPS Statistics overview (2015). Available at: https://baaps.org.uk/baaps_annual_audit_results_.aspx . Accessed May 02, 2017
- 2 Rhee JS, McMullin BT. Outcome measures in facial plastic surgery: patient-reported and clinical efficacy measures. Arch Facial Plast Surg 2008; 10 (03) 194-207
- 3 Black N. Patient reported outcome measures could help transform healthcare. BMJ 2013; 346: f167
- 4 Nelson EC, Eftimovska E, Lind C, Hager A, Wasson JH, Lindblad S. Patient reported outcome measures in practice. BMJ 2015; 350: g7818
- 5 Williams K, Sansoni J, Morris D, Grootemaat P, Thompson C. Patient-reported outcome measures: Literature review. Sydney: ACSQHC; 2016. . Available at https://www.safetyandquality.gov.au/wp-content/uploads/2017/01/PROMs-Literature-Review-December-2016.pdf . Accessed June 12, 2017
- 6 US Food and Drug Administration. Clinical outcome assessment qualification program (2015). Available at: http://www.fda.gov/Drugs/DevelopmentApprovalProcess/DrugDevelopmentToolsQualificationProgram/ucm284077.htm . Accessed June 12, 2017
- 7 Fatemi MJ, Rajabi F, Moosavi SJ, Soltani M. Quality of life among Iranian adults before and after rhinoplasty. Aesthetic Plast Surg 2012; 36 (02) 448-452
- 8 Pecorari G, Gramaglia C, Garzaro M. , et al. Self-esteem and personality in subjects with and without body dysmorphic disorder traits undergoing cosmetic rhinoplasty: preliminary data. J Plast Reconstr Aesthet Surg 2010; 63 (03) 493-498
- 9 Zojaji R, Keshavarzmanesh M, Arshadi HR, Mazloum Farsi Baf M, Esmaeelzadeh S. Quality of life in patients who underwent rhinoplasty. Facial Plast Surg 2014; 30 (05) 593-596
- 10 Carr T, Harris D, James C. The Derriford Appearance Scale (DAS-59): A new scale to measure individual responses to living with problems of appearance. Br J Health Psychol 2000; 5: 201-215
- 11 Picavet VA, Prokopakis EP, Gabriëls L, Jorissen M, Hellings PW. High prevalence of body dysmorphic disorder symptoms in patients seeking rhinoplasty. Plast Reconstr Surg 2011; 128 (02) 509-517
- 12 Simsek G, Demirtas E. Comparison of surgical outcomes and patient satisfaction after 2 different rhinoplasty techniques. J Craniofac Surg 2014; 25 (04) 1284-1286
- 13 Lavinsky-Wolff M, Dolci JEL, Camargo Jr HL. , et al. Vertical dome division: a quality-of-life outcome study. Otolaryngol Head Neck Surg 2013; 148 (05) 758-763
- 14 Lindsay RW. Disease-specific quality of life outcomes in functional rhinoplasty. Laryngoscope 2012; 122 (07) 1480-1488
- 15 Saleh AM, Younes A, Friedman O. Cosmetics and function: quality-of-life changes after rhinoplasty surgery. Laryngoscope 2012; 122 (02) 254-259
- 16 Most SP. Analysis of outcomes after functional rhinoplasty using a disease-specific quality-of-life instrument. Arch Facial Plast Surg 2006; 8 (05) 306-309
- 17 Günel C, Omurlu IK. The effect of rhinoplasty on psychosocial distress level and quality of life. Eur Arch Otorhinolaryngol 2015; 272 (08) 1931-1935
- 18 Bulut C, Wallner F, Plinkert PK, Baumann I. Development and validation of the Functional Rhinoplasty Outcome Inventory 17 (FROI-17). Rhinology 2014; 52 (04) 315-319
- 19 Klassen AF, Cano SJ, Scott A, Snell L, Pusic AL. Measuring patient-reported outcomes in facial aesthetic patients: development of the FACE-Q. Facial Plast Surg 2010; 26 (04) 303-309
- 20 Alsarraf R. Outcomes research in facial plastic surgery: a review and new directions. Aesthetic Plast Surg 2000; 24 (03) 192-197
- 21 Cingi C, Eskiizmir G. Deviated nose attenuates the degree of patient satisfaction and quality of life in rhinoplasty: a prospective controlled study. Clin Otolaryngol 2013; 38 (02) 136-141
- 22 Chauhan N, Warner J, Adamson PA. Adolescent rhinoplasty: challenges and psychosocial and clinical outcomes. Aesthetic Plast Surg 2010; 34 (04) 510-516
- 23 Mohammadshahi M, Pourreza A, Orojlo PH, Mahmoodi M, Akbari F. Rhinoplasty as a medicalized phenomenon: a 25-center survey on quality of life before and after cosmetic rhinoplasty. Aesthetic Plast Surg 2014; 38 (04) 615-619
- 24 Cingi C, Songu M, Bal C. Outcomes research in rhinoplasty: body image and quality of life. Am J Rhinol Allergy 2011; 25 (04) 263-267
- 25 Cingi C, Toros SZ, Cakli H, Gürbüz MK. Patient-reported outcomes after endonasal rhinoplasty for the long nose. J Craniofac Surg 2013; 24 (03) 1002-1006
- 26 Pusic AL, Klassen AF, Scott AM, Klok JA, Cordeiro PG, Cano SJ. Development of a new patient-reported outcome measure for breast surgery: the BREAST-Q. Plast Reconstr Surg 2009; 124 (02) 345-353
- 27 Klassen AF, Cano SJ, Alderman A. , et al. The BODY-Q: A patient-reported outcome instrument for weight loss and body contouring treatments. Plast Reconstr Surg Glob Open 2016; 4 (04) e679
- 28 Royal College of Surgeons. Patient reported outcome measures. Available at: https://www.rcseng.ac.uk/standards-and-research/standards-and-guidance/service-standards/cosmetic-surgery/clinical-quality-and-outcomes/patient-reported-outcome-measures/ . Accessed May 15, 2016
- 29 Klassen AF, Cano SJ, East CA. , et al. Development and psychometric evaluation of the FACE-Q scales for patients undergoing rhinoplasty. JAMA Facial Plast Surg 2016; 18 (01) 27-35
- 30 Pusic AL, Klassen AF, Scott AM, Cano SJ. Development and psychometric evaluation of the FACE-Q satisfaction with appearance scale: a new patient-reported outcome instrument for facial aesthetics patients. Clin Plast Surg 2013; 40 (02) 249-260
- 31 Klassen AF, Cano SJ, Alderman A. , et al. Self-report scales to measure expectations and appearance-related psychosocial distress in patients seeking cosmetic treatments. Aesthet Surg J 2016; 36 (09) 1068-1078
- 32 Klassen AF, Cano SJ, Schwitzer JA, Scott AM, Pusic AL. FACE-Q scales for health-related quality of life, early life impact, satisfaction with outcomes, and decision to have treatment: development and validation. Plast Reconstr Surg 2015; 135 (02) 375-386
- 33 Klassen AF, Cano SJ, Grotting JC. , et al. FACE-Q eye module for measuring patient-reported outcomes following cosmetic eye treatments. JAMA Facial Plast Surg 2017; 19 (01) 7-14
- 34 Klassen AF, Cano SJ, Schwitzer JA. , et al. Development and psychometric validation of the FACE-Q skin, lips, and facial rhytids appearance scales and adverse effects checklists for cosmetic procedures. JAMA Dermatol 2016; 152 (04) 443-451
- 35 Panchapakesan V, Klassen AF, Cano SJ, Scott AM, Pusic AL. Development and psychometric evaluation of the FACE-Q aging appraisal scale and patient-perceived age visual analog scale. Aesthet Surg J 2013; 33 (08) 1099-1109
- 36 Klassen AF, Cano SJ, Scott AM, Pusic AL. Measuring outcomes that matter to face-lift patients: development and validation of FACE-Q appearance appraisal scales and adverse effects checklist for the lower face and neck. Plast Reconstr Surg 2014; 133 (01) 21-30
- 37 Rasch G. Probabilistic Models for Some Intelligence and Attainment Tests. Copenhagen, Denmark: Danish Institute for Education Research; 1960
- 38 Cano SJ, Hobart JC. The problem with health measurement. Patient Prefer Adherence 2011; 5: 279-290
- 39 Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42 (02) 377-381
- 40 Liang MH, Fossel AH, Larson MG. Comparisons of five health status instruments for orthopedic evaluation. Med Care 1990; 28 (07) 632-642
- 41 Cohen J. Statistical Power Analysis for the Behavioral Sciences. New York, NY: Routledge Academic; 1988
- 42 Joseph AW, Ishii L, Joseph SS. Prevalence of body dysmorphic disorder and surgeon diagnostic accuracy in facial plastic and oculoplastic surgery clinics. JAMA Facial Plast Surg 2017; 19 (04) 269-274
- 43 Schwitzer JA, Sher SR, Fan KL, Scott AM, Gamble L, Baker SB. Assessing patient-reported satisfaction with appearance and quality of life following rhinoplasty using the FACE-Q appraisal scales. Plast Reconstr Surg 2015; 135 (05) 830e-837e