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FACE-Q Scales for Health-Related Quality of Life, Early Life Impact, Satisfaction with Outcomes, and Decision to Have Treatment: Development and Validation

Klassen, Anne F. D.Phil.; Cano, Stefan J. Ph.D.; Schwitzer, Jonathan A. B.A.; Scott, Amie M. B.Sc., M.P.H.; Pusic, Andrea L. M.D.

Plastic and Reconstructive Surgery: February 2015 - Volume 135 - Issue 2 - p 375–386
doi: 10.1097/PRS.0000000000000895
Cosmetic: Outcomes Article

Background: An ever-growing range of facial cosmetic products and treatments are available, but little clinical research is being performed to determine treatment outcomes from the patient’s perspective. The FACE-Q is a patient-reported outcome instrument composed of more than 40 independently functioning scales and checklists. The aim of this article is to describe the development and psychometric evaluation of five new FACE-Q scales.

Methods: FACE-Q scales were developed according to international guidelines for patient-reported outcome instrument development. The following FACE-Q scales and a single symptom checklist (Recovery Early Symptoms) were evaluated in this study: Psychological Wellbeing, Social Function, Satisfaction with Decision to Have Treatment, Satisfaction with Outcome of Treatment, and Early Life Impact of Treatment. Modern and traditional psychometric methods were used to examine reliability, validity, and responsiveness.

Results: The sample included 702 participants from three studies. The FACE-Q scales were found to be reliable, valid, and responsive to clinical change. These findings were supported by Rasch measurement theory (e.g., overall chi-square values, p ≥ 0.06; Person Separation Index ≥0.81), traditional psychometric (e.g., Cronbach alpha values ≥0.90) and responsiveness (i.e., significant improvement following face lift and lip treatment) analysis.

Conclusions: The FACE-Q measures concepts and symptoms important to facial aesthetic patients. The five scales and single symptom checklist described here can be used to measure what patients think about cosmetic treatments in a scientifically sound manner. As the cosmetics industry continues to expand, the patient perspective of treatment outcomes should be measured and reported.


Hamilton, Ontario, Canada; Plymouth, United Kingdom; and New York, N.Y.

From McMaster University; Plymouth University Peninsula Schools of Medicine and Dentistry; and Memorial Sloan Kettering Cancer Center.

Received for publication April 9, 2014; accepted June 6, 2014.

Preliminary findings for the Psychological Wellbeing and Social Function scales were presented orally at the 29th Annual Scientific Meeting of the British Association of Aesthetic Plastic Surgeons, in London, United Kingdom, September 27, 2013.

Disclosure: The FACE-Q is owned by Memorial Sloan Kettering Cancer Center. Drs. Cano, Klassen, and Pusic are co-developers 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. The other authors have no financial interests to disclose.

This work was supported by THE PLASTIC SURGERY FOUNDATION.

Andrea L. Pusic, M.D., M.H.S., Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, Room MRI-1007, New York, N.Y. 10065,

©2015American Society of Plastic Surgeons