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

Sir: We read with great interest your publication entitled “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;135:375–386) by Klassen et al. and we agree with the authors that as the cosmetics industry continues to expand, the patient perspective of treatment outcomes should be measured and reported. The point of view of the patient must be made scientifically valid and provable. The use of questionnaires is the only way to analyze scientifically and objectively the perception of the patient’s own body and that he or she would like to correct the defect. This FACE-Q instruments can be smoothly incorporated into research and/or routine clinical practice to better understand the recovery process and quality-of-life impact of facial aesthetics procedures and what patients think about their decision to undergo surgery.1 The BREAST-Q, a patient-reported outcome instrument, was developed with strict adherence to recommended international guidelines to address the lack of instruments for breast surgery patients. There are currently four modules, each of which includes a core of independent scales assessing six domains. In the original development study, all scales were found to fulfill criteria for good measurement.2 The Derriford Appearance Scale has been designed and developed to meet the need for an objective measure of the spectrum of psychological distress and dysfunction that is characteristic of disfigurements, deformities, and aesthetic problems of appearance.3 The Derriford Appearance Scale is highly sensitive as a measure of change following treatment with large and significant preoperative to postoperative reductions in full-scale and factorial scores of patients treated for facial features or bodily/sexual features. The Derriford Appearance Scale offers benefits for patient selection in both cosmetic and reconstructive plastic surgery and in the evaluation of outcome.4 Currently, we are carrying out a protocol subjecting all patients who undergo a cosmetic operation of any anatomical region to our original Italian questionnaire called the QoL-Q. This study aims to analyze the levels of information and awareness of patients requesting cosmetic surgery using a questionnaire completed by patients before surgery. The questionnaire is the original result of a collaboration between the Department of Plastic, Reconstructive and Cosmetic Surgery and the Institute of Philosophy of Scientific and Technological Activity of the Campus Bio-Medico University of Rome. We analyze the quality of the information given, the expectations and motivation of the patients who decided to undergo surgery, the degree of patient awareness about the proposed operation, and the aim of the required consent for cosmetic surgery. We recently published a pilot study that defines the results of the questionnaires obtained from patients only preoperatively.5 We propose that the questionnaire be applied preoperatively and postoperatively in all patients who undergo cosmetic surgery at our institution, and we would like to translate our questionnaire into multiple languages. We believe that any surgical technique and any medical action performed on a patient needs to be combined with a specific questionnaire that can assess the actual result on the patient. All scientific work of plastic surgery requires a questionnaire on quality of life and the perception of the body for it to be considered valid by any journal of international impact. DISCLOSURE The authors do not have any commercial associations that might pose or create a conflict of interest with information presented in this communication. No intramural or extramural funding supported any aspect of this work. Mauro Barone, M.D. Annalisa Cogliandro, M.D., Ph.D. Barbara Cagli, M.D., Ph.D. Paolo Persichetti, M.D., Ph.D. Division of Plastic and Reconstructive Surgery Campus Bio-Medico University of Rome Rome, Italy