Patients believe that cosmetic procedures affect their quality of life: An interview study of patient-reported motivations

The Use of Facial Fillers in Clinical Practice: The Level of Patient Satisfaction and an Overview of Common Clinical Complications

BACKGROUND

Patient esthetic satisfaction following facial fillers is an essential topic that should be studied as the number of individuals seeking treatment increases. The face is an essential component of the human body that is frequently associated with beauty, youthfulness, and health. Individuals may seek facial augmentation with fillers for a variety of reasons, such as congenital, acquired by means of aging or disease, or current aesthetic trends.

OBJECTIVE

The aim is to assess patient's aesthetic satisfaction and description of common clinical complications in relation to the facial filler injections.

METHOD

A cross sectional survey using a questionnaire derived from the global aesthetic improvement scale and WHO quality of life scale, convenience sampling was used to recruit patients attending cosmetic clinics, descriptive analysis and Chi-square methods were used to analyze the data.

RESULTS

In the study, 500 female participants, with an average age of 28.48 years, were included. Over 90% reported improvement after filler treatment, ranging from improved to very much improved. A statistically significant correlation was observed between patient satisfaction and the number of filler treatments and the anatomical injection site. However, no statistically significant correlation was found when considering age groups. Local side effects, such as swelling and redness at the injection site, were common but generally mild and of short duration.

CONCLUSION

Although the satisfaction level is currently high, practitioners in the field need to pay more attention to this important outcome, since understanding the patient's motivation and expectation before proceeding with the procedure is very important and can contribute significantly in determining patient satisfaction with the result.

The Use of Facial Fillers in Clinical Practice: The Level of Patient Satisfaction and an Overview of Common Clinical Complications

BACKGROUND

Patient esthetic satisfaction following facial fillers is an essential topic that should be studied as the number of individuals seeking treatment increases. The face is an essential component of the human body that is frequently associated with beauty, youthfulness, and health. Individuals may seek facial augmentation with fillers for a variety of reasons, such as congenital, acquired by means of aging or disease, or current aesthetic trends.

OBJECTIVE

The aim is to assess patient's aesthetic satisfaction and description of common clinical complications in relation to the facial filler injections.

METHOD

A cross sectional survey using a questionnaire derived from the global aesthetic improvement scale and WHO quality of life scale, convenience sampling was used to recruit patients attending cosmetic clinics, descriptive analysis and Chi-square methods were used to analyze the data.

RESULTS

In the study, 500 female participants, with an average age of 28.48 years, were included. Over 90% reported improvement after filler treatment, ranging from improved to very much improved. A statistically significant correlation was observed between patient satisfaction and the number of filler treatments and the anatomical injection site. However, no statistically significant correlation was found when considering age groups. Local side effects, such as swelling and redness at the injection site, were common but generally mild and of short duration.

CONCLUSION

Although the satisfaction level is currently high, practitioners in the field need to pay more attention to this important outcome, since understanding the patient's motivation and expectation before proceeding with the procedure is very important and can contribute significantly in determining patient satisfaction with the result.

Why different types of patients seek cosmetic treatments

The extent to which demographics drive patients to pursue minimally invasive cosmetic procedures is not well-understood. The aim of this project was to better understand how patient demographics impact motivations for cosmetic procedures, irrespective of the procedure desired. Patient-level information from the Cosmetic Motivation Database was evaluated using linear regression analyses to determine whether geographic region, age, gender, race, and education independently influence patients to pursue any cosmetic treatment or consultation. Patients in the Midwest reported fewer motivations related to cosmetic appearance, mental/emotional health, physical health, social life, and school/work success than those in the South. Patients younger than 45 years reported more mental/emotional health and cost/convenience motives compared to older patients. Men noted fewer motives related to cosmetic appearance, mental/emotional health, and cost/convenience but more related to school/work success. Non-White patients reported more cost/convenience motives. Participants with up to a high school diploma cited more mental/emotional health, physical health, social life, and school/work success motivations than those with post-bachelor's education. College graduates cited more school/work success motives than those with graduate-level education. In summary, patient's gender, education, age, location, and race affect why they seek cosmetic treatments. Future research may study younger and less educated patients to improve their access to treatment.

Cosmetic Injectable Treatments Improve Quality of Life in Patients With Multiple Serious Medical Comorbidities

Full facial rejuvenation with multi-modal cosmetic treatments can improve quality of life, leading to improvement in confidence and psychological function. These combination treatments are frequently administered at the same or sequential sessions and include neuromodulators and fillers. In patients with significant recent weight loss and other medical comorbidities, these treatments can help restore self-confidence and provide the encouragement they need to continue treatment for their comorbidities. We present a case report of a 71-year-old woman who experienced significant weight loss of 40 lbs (33% body weight) during the course of treatment of multiple medical comorbidities, including surgical intervention for compression fractures. Due to her facial appearance caused by this excessive weight loss, she experienced poor self-esteem as measured by the FACE-Q scales. She was treated cosmetically with 21cc of hyperdilute calcium hydroxyapatite (diluted in a 1:3 ratio; 7cc of calcium hydroxyapatite total) and neuromodulators to replace lost facial volume over three visits. At three months after her last treatment, her FACE-Q scores improved two-and-a-half-fold and fivefold on the psychological function and aging appraisal, respectively. Cosmetic treatments can dramatically improve the quality of life in patients with multiple medical co-morbidities. This population of patients is often excluded from clinical trials or other studies, representing a population for which we have little data on the efficacy of cosmetic treatments.

TFOS Lifestyle: Impact of cosmetics on the ocular surface

In this report the use of eye cosmetic products and procedures and how this represents a lifestyle challenge that may exacerbate or promote the development of ocular surface and adnexal disease is discussed. Multiple aspects of eye cosmetics are addressed, including their history and market value, psychological and social impacts, possible problems associated with cosmetic ingredients, products, and procedures, and regulations for eye cosmetic use. In addition, a systematic review that critically appraises randomized controlled trial evidence concerning the ocular effects of eyelash growth products is included. The findings of this systematic review highlight the evidence gaps and indicate future directions for research to focus on ocular surface outcomes associated with eyelash growth products.

Direct and Indirect Roles of Men in Determining Women Decision to Use Laser Procedures for Skin Care

Laser procedures for skin care is becoming increasingly popular and used by the global community and affect many aspects of human life. However, there is very little research on the role of men in women's decision to follow this dermatological procedure. This study aimed to identify the role of men in motivating women to choose laser-based procedure. A systematic literature review research design was applied in this study. A total of 27 papers were obtained by searching PubMed Central for the 2013-2022 editions. The extraction of samples and the motivation of patients or research respondents in choosing laser procedures for cosmetic treatments were conducted to obtain clues about the role of men in making these decisions. Only six studies explicitly reveal the role of men as motivators of women to perform laser-based dermatological procedures. Four of these six studies were conducted in Asia in countries with a high degree of collectivism. The remaining two studies reveal a minor role for men in women's motivation to choose dermatological procedures. Other studies only indirectly implicate the role of men through intrasexual competition, increased self-esteem, and the needs of the world of work. Limitations of the study lies in the non-specificity of the study sample in the female population, laser-based treatments, and the role of men in motivating women. The role of men in motivating women to perform laser-based skin care procedures is stated explicitly in collectivist cultures while only implicitly in individualist cultures. These findings indicate that the strategy of utilizing the added value of men to laser treatment procedures should be directed at the relationship between men and women in real terms in collective cultured countries.

Impact of botulinum toxin for facial aesthetics on psychological well-being and quality of life: Evidence-based review

BACKGROUND

There has been a steady growth of non-surgical minimally invasive procedures. In parallel, an ever-broadening range of clinicians has been engaging with botulinum toxin (BoNT) for aesthetic procedures, with reportedly compound positive impact on social health and psychological well-being.

OBJECTIVE

To identify and critically appraise current literature on the impact of BoNT injections into the upper face, as a sole treatment/combination with other modalities on facial aesthetics, psychological well-being, and quality-of-life.

METHODS

An evidence-based review was performed using advanced search from PubMed, Cochrane Library of Systematic Reviews, and Central Register of Controlled Trials databases . Only literature from inception to August, 2021 were considered. Eligibility criteria included human studies, FDA-approved BoNT applications, formulations, and dosages as a sole/multimodal approach; studies including patient-reported outcome tools psychometrically validated and facial lines-specific. Observer-reported outcome instruments were also considered for a thorough evaluation of outcomes.

RESULTS

Based on data investigations and participant assessments, all studies showed statistically significant improvement in psychosocial well-being and quality-of-life domains with a trend for highest impact when multiple upper facial areas are treated in a multimodal approach.

CONCLUSION

Aesthetic BoNT showed links to true health benefits for well-selected patients in addition to physical amelioration. However, the biological rational remains ambiguous. Well-designed controlled trials are needed, without pharmaceutical laboratories bias, in real clinical scenarios of patients paying for the interventions, often involving multiple areas with/without combined treatments. The persistence of positive outcomes following repetitive treatments provided by less experienced practitioners, potentially involving suboptimal patient selection and/or aesthetic results, warrants further investigation.

Is More Better? Benefits of Hyaluronic Acid Soft Tissue Filler on the Psychological- and Social-Related Quality of Life Dimensions

Background

Hyaluronic acid (HA) soft tissue fillers are popular for volumizing, sculpting, or rejuvenating the face. Their effect beyond these cosmetic benefits remains poorly defined, especially the changes in the psychological and social dimensions of health following cosmetic HA filler injections.

Objectives

To determine whether injecting more facial aesthetic units with HA soft tissue filler will improve the health-related quality of life dimension of patients.

Methods

A prospective study was conducted to assess the psychological and social benefits of treating multiple facial aesthetic units with HA soft tissue filler using 3 validated FACE-Q scales at baseline and 4 weeks posttreatment between January and August 2022.

Results

Data for 28 participants (n = 26 females [93%]; mean age: 49.7 ± 10.1 years) are available and reveal significant improvements on the psychological (+24.5; P < .001) and social functioning (+18.5; P < .001) FACE-Q scales and a reduction in the appearance-related distress score (-17.8; P < .001) posttreatment compared to baseline. A mean volume of 4.7 mL (range 1.0-15.2 mL) was injected. However, patients who had >2 facial aesthetic units injected did not statistically score better on the FACE-Q scales.

Conclusions

Facial treatment with HA fillers was associated with a marked improvement in the health-related quality of life dimension. While understanding patients' aims and motivation, an individualized treatment approach is strongly encouraged instead of a "whole-face" approach.

Level of Evidence 3

"Motivations, demography and clinical features of body dysmorphic disorder among people seeking cosmetic treatments: a study of 199 patients."

BACKGROUND

Motivations for getting aesthetic medicine treatments concern not only the improvement of the physical appearance but also internal aspects such as feeling more confident or happier. Body dysmorphic disorder (BDD) is a disorder that affects from 5 to 15% of aesthetic medicine clients and characterizes by an obsessive preoccupation with a non-visible or minimal defect in appearance.

AIMS

The aim of the study was to assess the main motivations, demography, and clinical features of body dysmorphic disorder among people seeking cosmetic treatments.

METHODS

A single-center study was performed using an anonymous questionnaire on 199 patients of the private aesthetic medicine clinic in Gdansk, Poland.

RESULTS

A typical client of an aesthetic clinic is a woman aged 40 to 50, with higher education, who undergoes aesthetic treatments more than twice a year, mainly with botulinum toxin injections. The most common motivations are the desire to achieve a fresh look, the will to reduce the signs of aging, and to invest in oneself. Furthermore, over 38% of patients stated that they were having critical and recurring thoughts about their appearance, which affected their daily functioning and caused a decrease in their well-being. Almost 20% of them performed repetitive activities, such as frequently looking in the mirror or asking others for opinions about their appearance. 15.6% of patients presented at least two characteristic features of BDD.

CONCLUSIONS

Patients seeking cosmetic treatments may suffer from body dysmorphic disorder, thus the need for aesthetic medicine practitioners to be aware of this disease.

Prevalence and associated factors of minimally invasive facial cosmetic surgery in Chinese college students

BACKGROUND

Minimally invasive facial cosmetic surgery (MIFCS) is becoming more and more popular and acceptable in Chinese young people, and it influences people in many aspects. However, there is little research on the associations between MIFCS and psychopathology in Chinese college students. The purpose of this study was to identify the prevalence of MIFCS and its associated factors among Chinese college students.

METHODS

A cross-sectional design was applied in this study. A total of 8089 students completed an online questionnaire on demographic data, depressive symptoms (Self-Rating Depression Scale), anxiety symptoms (Self-Rating Anxiety Scale) and MIFCS. Logistic regression was used to identify independent factors associated with MIFCS.

RESULTS

The prevalence of MIFCS in Chinese college students was 2.7% (221/8098). Students with MIFCS were more likely to be from urban areas, from a single child household, experience depression or anxiety and have a history of smoking (all p < 0.05). They were also less likely to be right-handed or have a good relationship with father or mother (all p < 0.05). Binary logistic regression showed that older age (OR,1.162; 95%CI [1.061,1.273]), female sex (OR,1.837; 95%CI [1.352, 2.497]), community (urban) (OR,0.601; 95%CI [0.441,0.818]), right-handedness (OR,0.668; 95%CI [0.454,0.985]), depressive symptoms (OR, 4.708; 95%CI [1.690,13.112]), family income (30,000-70,000 yuan per year) (OR,0.572; 95%CI [0.403,0.812]) and smoking (OR,1.571; 95%CI [1.09,2.423]) were independently associated with MIFCS.

CONCLUSIONS

Minimally invasive facial cosmetic surgery (MIFCS) is very common in Chinese college students, indicating the importance of paying attention to MIFCS. This study provides valuable evidence for college counselors and doctors in the cosmetic department to provide better and healthier services to students who undergo MIFCS, especially those with depressive symptoms.

Impact of Minimally Invasive Aesthetic Procedures on the Psychological and Social Dimensions of Health

Background:

The impact on psychosocial health of injectable facial treatments such as hyaluronic acid fillers and botulinum toxin type A remains poorly defined. The aim of this study was to measure changes in psychosocial health following aesthetic intervention with injectables in routine clinical practice using the validated FACE-Q patient-reported outcome measure.

Methods:

This was a prospective assessment of patients presenting at a single center for the first time for aesthetic treatment of the face with injectables in February 2020. Participants completed 3 FACE-Q scales at the baseline and again 2 weeks posttreatment: Psychological Function; Social Function; and Appearance-related Psychosocial Distress.

Results:

Complete data were available for 35 individuals (n = 32 women [91%]; mean age: 45.9 ± 13.8 years). Twenty-nine (83%) were treated with hyaluronic acid filler (mean: 2.3 ± 1.3 syringes), and 12 (34%) received onabotulinumtoxinA (mean: 2.0 ± 0.7 areas of the upper face). There were significant improvements on each FACE-Q scale posttreatment: mean change in Psychological Function score was +12.4 [95% CI: 7.9, 16.9; P < 0.001; standardized effect size by Cohen’s d: 0.93]; mean change in Social Function score was +7.9 (95% CI: 3.3, 12.5; P = 0.001; effect size: 0.50); and mean change in Appearance-related Psychosocial Distress score was –20.9 (95% CI: –27.4, –14.3; P < 0.001; effect size: 1.27).

Conclusions:

Aesthetic treatment with injectables was associated with significant improvements in patient-reported psychological and social functioning and reductions in appearance-related distress. This change underlines the value of these therapies for improving psychosocial health in well-selected patients.

Observer-Reported Outcomes and Cosmetic Procedures: A Systematic Review

BACKGROUND

Cosmetic procedures have demonstrated beneficial effects on physical appearance based on anatomic markers as well as patient-perceived self-image and quality of life. Recent studies of observer-reported outcomes (OROs) suggest an additional benefit from aesthetic interventions.

OBJECTIVE

The authors aimed to review the evidence of OROs from cosmetic procedures performed on the head and neck.

PATIENTS, METHODS AND MATERIALS

PubMed, Embase, and Cochrane Library databases were searched for relevant studies, yielding 24 included original investigations.

RESULTS

These studies captured 686 total patients, 8,257 observer evaluations, and a variety of interventions including face-lifts, blepharoplasty, rhinoplasty, and minimally invasive treatments including botulinum toxins and hyaluronic acid fillers. Forty-one distinct reported OROs were grouped into 12 descriptive domains. Domains were further grouped into 3 higher-order categories: aesthetics and wellness, social capacities, and skills and competencies. Improved perception after cosmetic intervention is most reproducibly demonstrated for the following ORO domains: age, attractiveness, sociability, relationship success, and occupational and financial competency.

CONCLUSION

The synthesized findings imply a tertiary layer of benefit for cosmetic intervention beyond anatomical and patient-centered outcomes through enhanced perceptions of others. These findings may inform the pre-procedure risk-benefit discussion with patients of cosmetic medicine and drive future research into longitudinal outcomes.

Office practices that may improve the experience of the cosmetic dermatology patient

Patients presenting for cosmetic dermatology procedures are often interested in lifestyle enhancement rather than treatment of an inflammatory or neoplastic disease or condition. In addition to good clinical outcomes, they may also particularly value the quality of the patient experience in the dermatology office. A list of beneficial practices that may improve patient experience was generated by interviewing staff members from several US practices, including clinic administrators, nurses, nurse managers, medical assistants, physician assistants, patient care coordinators, and dermatologists. Each was asked ten open-ended questions. The list of beneficial practices thereby obtained was ordered based on the number of participants who recommended each practice. Practices were further categorized into four categories: clinician improvement, administrative improvement, clinic improvement, and team improvement. For clinics providing cosmetic dermatology services, certain well-accepted beneficial practices may improve patient experience.

Types of Cosmetic Procedures Requested by Different Types of Patients and the Reasons for These Preferences

BACKGROUND

The type of cosmetic dermatologic procedures patients' desire may be influenced by demographic factors.

OBJECTIVE

To better understand the type of cosmetic procedures requested by patients of different age, gender, education, race, and geographic location. To understand the most common motivations of patients who requested particular types of treatments.

MATERIALS AND METHODS

Multicenter data from the Cosmetic Motivation Database were analyzed. Bivariable analyses and linear regressions were undertaken to determine whether patient demographic features were associated with particular procedures of interest.

RESULTS

Patients younger than 45 years were more interested in acne scar treatment, laser hair removal, liposuction, and tattoo removal. Older patients were more likely to want soft-tissue fillers and wrinkles and jowls tightening treatment. Non-White patients were more likely to be interested in laser hair removal, liposuction, cellulite treatment, and tattoo removal. Types of procedures desired varied by the geographic region but not by the educational level. Different motivations drove patients who wanted different types of treatments.

CONCLUSION

Different types of patients demand different types of cosmetic treatments, and the motivations of patients who ask for particular procedures also differ. Better understanding of patient preferences may help physicians allocate resources and meet patient needs.

Treatment Motivations and Expectations in Patients with Actinic Keratosis: A German-Wide Multicenter, Cross-Sectional Trial

Patient-centered motives and expectations of the treatment of actinic keratoses (AK) have received little attention until now. Hence, we aimed to profile and cluster treatment motivations and expectations among patients with AK in a nationwide multicenter, cross-sectional study including patients from 14 German skin cancer centers. Patients were asked to complete a self-administered questionnaire. Treatment motives and expectations towards AK management were measured on a visual analogue scale from 1-10. Specific patient profiles were investigated with subgroup and correlation analysis. Overall, 403 patients were included. The highest motivation values were obtained for the items "avoid transition to invasive squamous cell carcinoma" (mean ± standard deviation; 8.98 ± 1.46), "AK are considered precancerous lesions" (8.72 ± 1.34) and "treating physician recommends treatment" (8.10 ± 2.37; p < 0.0001). The highest expectation values were observed for the items "effective lesion clearance" (8.36 ± 1.99), "safety" (8.20 ± 2.03) and "treatment-related costs are covered by health insurance" (8.00 ± 2.41; p < 0.0001). Patients aged ≥77 years and those with ≥7 lesions were identified at high risk of not undergoing any treatment due to intrinsic and extrinsic motivation deficits. Heat mapping of correlation analysis revealed four clusters with distinct motivation and expectation profiles. This study provides a patient-based heuristic tool for a personalized treatment decision in patients with AK.

Safety And Efficacy Of Princess® FILLER Lidocaine In The Correction Of Nasolabial Folds

Purpose

Nasolabial folds (NLFs) are one of the most noticeable signs of facial aging. NLFs negatively affect self-confidence and social acceptance often leading to a person’s desire to improve their appearance using dermal fillers. The hyaluronic acid injectable gel implant Princess^® FILLER Lidocaine (PFL) is a minimally invasive easy to administer the product. In this investigation, we assessed the safety and efficacy of PFL to correct moderate to severe NLFs over a 36-week period.

Methods

Adult women and men with moderate to severe NLFs received one injection of PFL to both NLFs. After 2 weeks, a touch-up treatment could be performed, if deemed necessary by the investigator. The change in NLF severity was assessed using the Nasolabial Fold Severity Rating Scale (NFL-SRS) developed by Croma-Pharma and the Global Aesthetic Improvement Scale (GAIS).

Results

Out of 60 analyzed subjects, 59 (98.3%) had improved their NLF severity by at least 1 grade on the NFL-SRS at week 4, 58 subjects (96.7%) at weeks 24 and 36. All subjects showed aesthetic improvement (GAIS), at weeks 4 and 24. The investigator judged the aesthetics as very much improved (score of 1) in 45 (75.0%) at week 4, 48 (80.0%) at week 24, and in 39 of 60 subjects, respectively (65.0%) at week 36. Thirty-six weeks post-initial treatment, 56 of 60 subjects (93.3%) were very satisfied or satisfied with the treatment. Adverse device effects (ADEs) were mild or moderate and resolved at latest 25 days post-onset. The most commonly reported ADEs were injection site hematoma and injection site pain.

Conclusion

PFL was safe and effective in reducing the severity of NLFs. Most subjects were (very) satisfied with the treatment outcome throughout a 36 weeks investigation period.