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A Systematic Review of Patient-Reported Outcomes for Cosmetic Indications of Botulinum Toxin Treatment

Wang, Jenny BS*; Rieder, Evan A. MD

doi: 10.1097/DSS.0000000000001878
Review Article

BACKGROUND Botulinum toxin (BTX) injection is the most popular cosmetic procedure in the United States. Although facial rejuvenation is considered cosmetic, physical appearance has meaningful impact on quality of life (QOL), best measured by patient-reported outcomes (PROs). Patient-reported outcomes are now often required for Food and Drug Administration approval of new pharmaceuticals.

OBJECTIVE This review summarizes the PRO instruments and outcomes in evaluating patient QOL after aesthetic BTX administration.

METHODS PubMed, MEDLINE, Embase, Cochrane Library, CINAHL Plus, and PsycINFO databases were searched for prospective studies using PRO instruments to directly evaluate the success of cosmetic BTX intervention.

RESULTS Five psychometrically validated, facial rhytid-specific PRO tools are currently used in clinical research. Most studies addressing PROs after cosmetic BTX treatment use 1-item Likert scales evaluating overall satisfaction. BTX treatment generally resulted in improved satisfaction and QOL metrics, such as perception of youthfulness, attractiveness, restedness, affect, mood, and self-confidence. Combination treatments, whether of multiple facial areas or with multiple treatment modalities, may improve PROs even further.

CONCLUSION Validated, specific PRO instruments can be used to better understand patient expectations in regards to cosmetic treatment, thus helping aesthetic dermatologists maximize patient satisfaction and retention.

*New York University School of Medicine, New York, New York;

The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York

Address correspondence and reprint requests to: Evan A. Rieder, MD, The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, 240E. 38th Street, 11th Floor, New York, NY 10016, or e-mail:

The authors have indicated no significant interest with commercial supporters.

© 2019 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.
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