Prospective Cohort Study Investigating Changes in Body Image, Quality of Life, and Self-Esteem Following Minimally Invasive Cosmetic Procedures

Hyaluronic Acid-based Fillers for Facial Rehabilitation in Inherited Neuropath

Charcot-Marie-Tooth (CMT) disease is the most prevalent inherited neuromuscular disorder. It commonly leads to various musculoskeletal deformities, profoundly impacting the quality of life. The present case report explores the often under-recognized body image dissatisfaction in CMT, highlighting the potential benefits of a multidisciplinary approach to enhance aesthetic satisfaction. We present a case of a 54-year-old woman with CMT, who experienced chronic facial asymmetry, significantly impairing her quality of life. Seeking cosmetic enhancement, she underwent two sessions of facial treatment using hyaluronic acid-based fillers. The first session focused on correcting right mandibular hypoplasia and other facial asymmetries, whereas the second session focused on enhancing perioral aesthetics. The treatment resulted in significant aesthetic improvements, as demonstrated by high ratings in both the Physician Global Aesthetic Improvement Scale and the Subject Global Aesthetic Improvement Scale. Besides, there was a marked reduction in lip corner asymmetry, the patient's primary concern. The role of hyaluronic acid fillers in facial aesthetic enhancement is well established, and their application in the context of CMT is a promising under-investigated field, to our knowledge. This case study highlights the importance of considering body image in CMT patients and suggests that minimally invasive aesthetic procedures can be a valuable addition to the multidisciplinary care of patients with inherited neurological disorders. Despite being a single-case study, the significant improvement in the patient's aesthetic satisfaction requires further research in this field.

Efficacy of Pegylated Hyaluronic Acid Filler Enriched with Calcium Hydroxyapatite: A 24-Week Post-Market, Observational, Prospective, Open-Label, Single-Center Study

Recently, thanks to the greater discovery of the mechanisms of facial aging, an alternative to invasive plastic surgery has found space with less invasive aesthetic procedures, also based on an increasingly pressing request. We are specifically referring to dermal filler injection into or under the skin which leads to immediate rejuvenation and aesthetic improvements. In this study, we wanted to analyze the results obtained through the use of NEAUVIA Organic Stimulate, particularly with regard to its effectiveness, which is a cross-linked polymeric hydrogel, containing stabilized sodium hyaluronate 26 mg/mL and calcium hydroxyapatite (1%), glycine and L-proline in buffer pyrogen-free water, in its main indication, namely, the temporary correction of congenital and acquired deficiencies of the soft tissues of the face by intradermal injection. Initially, 70 patients were enrolled, but 10 did not complete the study due to non-observance of the investigation rules, so they were excluded from the protocol. The collected data demonstrate an efficient mechanical effect of the pegylated polymeric acid matrix enriched with low concertation of calcium hydroxyapatite and in accordance with other evidence in vitro and in vivo, and the mechanical support of the interstitial connective space improves the homestays of the anatomical layer rebalancing the physiological activity of the dermis cells.

Consumers' body image expressions: Reflection of a Snow White or an Evil Queen

Introduction

The aim of this paper is to explore how minimal-self impacts the body image, projecting it as a reflection of one's approach toward their health and mental well-being.

Methods

The study takes qualitative data from two countries India and Germany and draws on a qualitative study of 20 individuals who are involved in some kind of physical activity for a long time. This paper examines the body image perspectives from Grimms Brothers fairytale characters showcasing fit and healthy perspectives on Snow White side and projected and superfluous perspectives on Evil Queen side. The study also provides a model deciphering the rationale for both the reflections.

Results

The body image projection from Snow White perspectives (success & dedication, self-esteem, bodybuilding, and cosmetic surgery) relates to positive reflection of oneself with focus on fitness, discipline, and mental rejuvenation in life. Notably, Evil Queen perspectives (unrealistic makeover, dark side of social media, gain an edge over others, and mental benchmarking with fair skin) reveal these facets as motivators to equip their body as means of physical non-verbal communication assets.

Conclusion

Analysis shows that there is no clear white or black view of health and fitness projection via body image but it's a gray line that gives wholesome fitness either a holistic mental peace or a competitive or success-oriented approach.

Predictors and Moderators of Quality of Life in Male Users of Anti-Aging Products

For most individuals, changes occurring during the aging process may cause dissatisfaction and concerns regarding body image, with implications on quality of life (QoL). The aim of this study was to assess the contribution of sociodemographic and psychological variables and the type of anti-aging products/treatments on men's QoL, as well as to evaluate the moderating role of aging perceptions in the relationship between psychological morbidity and QoL. This study used a cross-sectional design and included a sample of 111 male participants who used anti-aging cosmetic products/aesthetic treatments. Participants were assessed on body image, self-esteem, psychological morbidity, aging perceptions, traits of perfectionism, and QoL. Results suggested that psychological morbidity and perceptions of the aging process as chronic negatively contributed to QoL, and emotional representations of aging moderated the relationship between psychological morbidity and QoL. According to the findings, psychological intervention programs to improve QoL should focus on men with higher levels of psychological morbidity and more negative emotional responses to the aging process.

Exploring the quality of life of cosmetic users: A cross-sectional analysis from eight Arab countries in the Middle East

BACKGROUND

The use of cosmetic products is growing in dominance in the Arab population, making it essential to measure its effects on users. The production of cosmetics has been largely driven by consumerism and a bid to keep abreast with the latest trends in the beauty industry with less attention on how the users' quality of life (QoL) is affected.

AIMS

This study aims to investigate the effect of cosmetic products on users' quality of life in eight Arab countries.

METHODS

A cross-sectional study was carried out using an online data collection approach. A validated and specialist instrument tool called BeautyQoL, which consists of five domains and a total of 52 questions, was distributed to a sample of 2219 cosmetic users. Descriptive and inferential statistical analysis was done using SPSS® version 26.0.

RESULTS

The mean age of participants was 34 ± 11.25 years, and more women were represented in the sample (71%) than men. The majority of respondents had oily skin type (39.6%) and tan skin tone (30.4%). QoL through cosmetic use is computed with a mean score of 51 out of 100. The users' mean score satisfaction from cosmetic use is centred on attractiveness (56.1), followed by self-confidence (51.8). Cosmetics have a statistically significant effect on participants who are young adults, women, single, and employed with high income. As the respondents' skin tone deepens from very fair to dark, the mean score for each domain significantly increases, whereas when skin type changes from very oily to dry, the mean score for each domain decreases.

CONCLUSION

The effect of cosmetics on the users' QoL is limited, contrary to the narrative commonly portrayed in cosmetics' advertisements. Therefore, the use of cosmetics among the Arab population should be from an informed perspective of their specific needs instead of conforming to the viral trends pedaled by influencers and bloggers on social media, which might be irrelevant for them.

Patient reported outcome measures (PROMS) for body image in dermatology: A systematic review

INTRODUCTION

It is widely acknowledged that negative body image perception is linked to anxiety, depression, and body dysmorphic disorder. However, there is no gold standard, body image related patient reported outcome measure in use, specific for dermatologic disease, despite evidence to suggest a high prevalence of mental health problems relating to body image in this group of patients.

AIM

The aim of this study was to perform a review of body image Patient Reported Outcome Measures (PROMs) used in dermatology and to evaluate their effectiveness.

METHODS

Searches were performed in the major databases. Two investigators independently performed full text evaluation by applying an established checklist to evaluate the conceptual model, content validity, reliability, construct validity, scoring and interpretability and respondent burden.

RESULTS

Six different PROMs were identified of which only one was fully validated. There was a significant lack of patient involvement in the development of PROMs in this context.

CONCLUSIONS

We therefore encourage further research in this field to improve the quality of evidence to better understand the relationship between mental health and dermatologic disease.

"We should educate the public that cosmetic procedures are as safe as normal medicine": Understanding corporate social responsibility from the perspective of the cosmetic procedures industry

The cosmetic procedures industry is profitable and expanding. Through its premise and promotion, the industry contributes to unrealistic societal appearance pressures considered harmful to body image. In the context of limited regulation, there is an uneasy reliance on businesses in the sector to act in a socially responsible way. Corporate social responsibility (CSR) refers to voluntary business practices designed to benefit society, and engagement in CSR is shaped by extrinsic and intrinsic drivers. This study aimed to explore how senior UK industry professionals view CSR as it applies to their sector and to body image. Findings from 14 semi-structured interviews show that participants' understanding of CSR was limited to a myopic focus on patients. Little reflexivity was demonstrated in relation to the industry's responsibilities concerning negative body image in society. More broadly, the drivers of socially responsible practice were overwhelmingly extrinsic - oftentimes explicitly linked to bolstering or protecting company and/ or industry reputation. Participants, acknowledging a lack of intrinsic motivation for CSR across the sector, were largely in support of greater regulation. This research contributes to understandings of how the adoption of a CSR agenda might combine with regulatory efforts to curb the industry's impact on negative body image.

Impact on the Quality of Life Following Minimally Invasive Cosmetic Procedures: Assessment Through the Skin Rejuvenation Outcome Evaluation Questionnaire

BACKGROUND

Aesthetic procedures are widely performed by dermatologists and plastic surgeons, often with subjective results. In cosmetic dermatology, there is a lack of studies that use accurate instruments to assess result outcomes. Quality of life (QoL) questionnaires can objectively assess results.

OBJECTIVE

To assess the impact of nonsurgical facial cosmetic procedures on QoL.

MATERIALS AND METHODS

This was a longitudinal observational study performed with 81 patients who underwent facial cosmetic procedures at a University Hospital in Rio de Janeiro, Brazil. The Skin Rejuvenation Outcome Evaluation questionnaire, previously adapted and translated to the Portuguese language spoken in Brazil, was selected, and the results were compared with the Dermatology Life Quality Index. The impact on QoL was statistically evaluated after the interventions.

RESULTS

The Skin Rejuvenation Outcome Evaluation scores after the procedures were significantly higher than before (p < .001), independent of sociodemographic characteristics. Patients treated with botulinum toxin and dermal fillers showed greater satisfaction than those treated with laser, chemical peels or microneedling.

CONCLUSION

Minimally invasive cosmetic procedures result in improvements in QoL. The use of translated, adapted, and validated questionnaires favors the comparison of results among different populations and reinforces the confidence on the results of established cosmetic treatments.

Bilateral Gluteal Augmentation With Hyperdilute Calcium Hydroxylapatite Microspheres Performed Using the Bella Vida Instant Brazilian Butt Lift (BBL)™

For decades, aesthetic medical procedures have sought to improve patient appearance, comfort, and self-confidence. In more recent years, a growing interest in body contouring cosmetic procedures has emerged, in large part due to increased transparency in procedures and improved outcomes with minimally invasive procedures. Notably, several biostimulatory fillers have emerged as a suitable treatment modality due to their relatively low cost, low pain, short downtime, high tunability, and sustained biostimulatory effect. One volumizing biostimulatory filler, Radiesse® (Merz Aesthetics, Frankfurt, Germany), consists of calcium hydroxylapatite microspheres suspended in a carboxymethyl cellulose gel. When injected, Radiesse immediately volumizes the injection site and initiates neocollagenesis and neoelastogenesis. One technique, the Bella Vida Instant Brazilian Butt Lift (BBL)™, is a fast, safe, and minimally invasive alternative to surgical gluteal augmentation that accomplishes morphological remodeling, increases volumization, and improves shape and patient satisfaction. This technical report provides the clinical basis, materials, and methods for implementing the Bella Vida Instant BBL™ in aesthetic practices. 

An abbreviated 10-item, two-factor version of the Body Image Quality of Life Inventory (BIQLI-10): The U.S. Body Project I

The objective of this study was to re-examine the factor structure of the Body Image Quality of Life Inventory (BIQLI), a measure that quantifies perceived effects of one's body image on various aspects of psychosocial functioning. Data on the 19-item BIQLI from a community sample of 11,620 U.S. men and women were split into cross-validation samples and underwent exploratory and confirmatory factor analysis. An abbreviated 10-item, two-factor version of the BIQLI (BIQLI-10) was identified. The BIQLI-10 measures Social Relations & Psychological Well-Being with one subscale and Appearance & Body Management Activities with the other. Internal consistency was high for each subscale. The BIQLI-10 largely retained the convergent validity of the original 19-item BIQLI, as evidenced by nearly identical correlations with appearance evaluation, overweight preoccupation, body surveillance, appearance pressures, and appearance ideal internalization. Results also supported strong measurement invariance for the BIQLI-10 by age group, gender, sexual orientation, racial group, and weight status. Findings from this study suggest researchers may use this abbreviated version to increase nuance in the measurement of body image quality of life and reduce participant burden without compromising the psychometric integrity of the BIQLI. Further, results support the comparison of BIQLI-10 subscale scores across diverse groups.

Predictors of Acceptance of Cosmetic Surgery: Instagram Images-Based Activities, Appearance Comparison and Body Dissatisfaction Among Women

BACKGROUND

This study aimed to test a model in which Instagram images-based activities related to self, friends, and celebrities were associated with acceptance of cosmetic surgery via Instagram appearance comparison and body dissatisfaction. We predicted that Instagram use for images-related activities involving celebrities and self (but not friends) was associated with acceptance of cosmetic surgery both directly and indirectly.

METHODS

The study participants were 305 Italian women (mean age, 23 years). They completed a questionnaire containing the Instagram Image Activity Scale, the Instagram Appearance Comparison Scale, the Body Shape Questionnaire-14, the Acceptance of Cosmetic Surgery Scale. A path analysis was performed in which the Instagram images-based activities were posited as predictors of the Instagram appearance comparison, body dissatisfaction and acceptance of cosmetic surgery, respectively.

RESULTS

We found that only image-based activities related to celebrities and self were significantly related to acceptance of cosmetic surgery, whereas friends' Instagram-related activities were not significantly related to this criterion variable. Moreover, the indirect effect of both Instagram self- and celebrities-images activities on acceptance of cosmetic surgery through Instagram appearance comparison and body dissatisfaction was significant. Friends' Instagram images-related activities were not associated with acceptance of cosmetic surgery.

CONCLUSIONS

Overall, these findings provide information about the role that activities carried out on Instagram, appearance comparison and body dissatisfaction, play on the acceptance of surgery for aesthetic reasons among women. The study highlighted the importance for surgeons to consider some psychological aspects and the influence of sociocultural factors on the interest for cosmetic surgery.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Perception of cosmetic surgery and associated side effects: A content analysis study of South Korean female college students

ABSTRACT

This study explores the perception of female college students in South Korea regarding cosmetic surgery and its side effects.Face-to-face interviews were conducted with 28 female college students over a period of 4 months, starting in October 2019. All participants were female college students who had not undergone cosmetic surgery. The collected data were analyzed qualitatively, using conventional content analysis.Four categories and 13 subcategories were extracted from 112 meaningful codes reflecting perceptions related to cosmetic surgery and its associated side effects. The 4 categories that emerged in the study were: "reaction to the side effects of cosmetic surgery", "reasons for cosmetic surgery", "prospects of the participant's own cosmetic surgery", and "prerequisites for decision-making regarding cosmetic surgery".The results of this study could be used as reference material by surgeons to ensure safer cosmetic surgeries. A sufficient consideration period and patient education prior to selective cosmetic surgery would minimize patient complaints and expand the base of safe cosmetic surgery.

Multimodal Facial Aesthetic Treatment on the Appearance of Aging, Social Confidence, and Psychological Well-being: HARMONY Study

Background

A global approach to facial rejuvenation involves multiple treatment modalities.

Objectives

The aim of this study was to evaluate the impact of multimodal facial aesthetic treatment on self-reported psychological and social outcomes.

Methods

HARMONY, a prospective, multicenter, 4-month study, enrolled patients aged 35 to 65 years to receive on-label treatment with a combination of hyaluronic fillers (VYC-20L, HYC-24L, and/or HYC-24L+), onabotulinumtoxinA, and bimatoprost. Fillers were injected on Day 1, with touch-ups performed on Day 14. OnabotulinumtoxinA was injected at Month 3 into glabellar lines and/or crow’s feet lines. Patients applied bimatoprost to eyelashes once daily for 17 weeks. Mean change from baseline on FACE-Q Psychological Well-being and Social Confidence Scales, FACE-Q Aging Appearance Appraisal Scale, and FACE-Q Age Appraisal Visual Analog Scale were assessed.

Results

Of 100 patients treated, 93 were evaluated at 4 months posttreatment. Significant improvement vs baseline was observed on the FACE-Q Scales for Psychological Well-being (mean change, −19.9; P < 0.00001), Social Confidence (mean change, −18.2; P < 0.00001), and Aging Appearance (mean change, −28.5; P < 0.0001). On average, patients’ self-assessed age was 0.1 years older than actual age at baseline and 4.5 years younger at Month 4 (P < 0.001 vs baseline). Forty-two patients experienced adverse events, all mild to moderate.

Conclusions

Multimodal, full facial aesthetic treatment improves patients’ self-reported psychological well-being, social confidence, aging appearance, and perceptions of chronologic age.

Level of Evidence: 4

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.

Effect of clinical photography on postprocedure patient satisfaction in female patients who underwent nonsurgical rhinoplasty

STUDY DESIGN

A prospective clinical study.

BACKGROUND

To the best of our knowledge, there is no study in the literature that addresses the effect of showing comparative photographs in the follow-up period to patients who had undergone nonsurgical rhinoplasty on patient satisfaction.

OBJECTIVES

To examine the effect of showing preprocedure and postprocedure photographs to patients in the follow-up period on patient satisfaction.

METHODS

It was a nonsimultaneous prospective study that included patients suitable for nonsurgical rhinoplasty. Photographs were taken during routine follow-up after 1 month of the procedure, and patients were asked to fill the Derriford Appearance Scale 24 (DAS24) and Rhinoplasty Outcome Evaluation (ROE) questionnaires. Next, after the preprocedure and postprocedure photographs were shown to the patients, they were asked to complete the DAS24 and ROE questionnaires again.

RESULTS

The study included 265 female patients. The mean age of the patients was 35.11 ± 8 (18-61 years). Before the preprocedure and postprocedure photographs were shown, the DAS24 score was 52.2 ± 14.26 and the ROE score was 75.91 ± 11.91. After the photographs were shown, the DAS24 score was found to be 40.80 ± 13.25 and the ROE score as 87.722 ± 8.56. Therefore, significant improvement in DAS24 and ROE scores and an increase in patient satisfaction were observed after the preprocedure and postprocedure photographs were shown (p = 0.01, p < 0.05).

CONCLUSION

Showing preprocedure and postprocedure photographs in the follow-up period to patients who underwent nonsurgical rhinoplasty leads to greater patient satisfaction with the surgery and their self-image.

The cosmetic surgery paradox: Toward a contemporary understanding of cosmetic surgery popularisation and attitudes

Modern women feel compelled to meet near-impossible standards of beauty. For many, this pursuit ultimately culminates in cosmetic surgery - a radical form of beautification that is rapidly becoming popular worldwide. Paradoxically, while prevalent, artificial beauty remains widely unaccepted in contemporary society. This narrative review synthesizes feminist dialogue, recent research, and real-world case studies to argue that female beauty standards account for both the growing popularity of cosmetic surgery and its lack of mainstream acceptance. First, we implicate unrealistic beauty standards and the medicalization of appearance in popularizing cosmetic surgery. Second, we analyze how negative attitudes toward cosmetic surgery are also motivated by unrealistic beauty standards. Finally, we generate a synthesized model of the processes outlined in this review and provide testable predictions for future studies based on this model. Our review is the first to integrate theoretical and empirical evidence into a cohesive narrative that explains the cosmetic surgery paradox; that is, how cosmetic surgery remains secretive, stigmatized, and moralized despite its surging popularity.

Psychosocial Differences Between Transgender Individuals With and Without History of Nonsurgical Facial Injectables

BACKGROUND

Considerable research has explored psychosocial characteristics of individuals who seek aesthetic procedures as well as psychological changes experienced after successful treatment. Little research, however, has explored the experiences of transgender individuals who have undergone nonsurgical injectable procedures (NSIPs).

OBJECTIVES

This study examined theoretically relevant psychosocial characteristics of transgender individuals who have and have not undergone NSIPs.

METHODS

An online survey of demographic and psychosocial constructs was disseminated through transgender-specific support groups and Facebook groups from December 2019 to February 2020. Psychosocial measures included self-esteem (Rosenberg Self-Esteem Inventory), anticipated discrimination (Intersectional-Anticipated Discrimination), gender identity and physicality congruence (Transgender Congruence Scale), body image (Body Image Quality of Life Inventory), and overall satisfaction with facial appearance (FACE-Q Face Overall). The Mann-Whitney U test assessed differences by history of NSIPs, and the Kruskal-Wallis test assessed gender and racial differences. A P-value of <0.05 was considered significant.

RESULTS

Participants (N = 101) were transfeminine (n = 58), transmasculine (n = 31), gender-diverse (n = 12), and mostly (71%) white. Almost two-thirds of respondents (62%) reported using NSIPs; 6 participants reported undergoing NSIPs from non-licensed providers. History of NSIPs was associated with greater self-esteem (P < 0.01), less anticipated discrimination (P < 0.01), greater physicality and gender identity congruence(P < 0.001), greater body image quality of life (P < 0.001), and greater satisfaction with overall facial appearance (P < 0.01).

CONCLUSIONS

Use of NSIPs was associated with more positive psychosocial symptoms. Experiences with NSIPs may play an important role in psychosocial functioning for transgender individuals.

LEVEL OF EVIDENCE 3

Do Genital Cosmetic Procedures Improve Women's Self-Esteem? A Systematic Review and Meta-Analysis

BACKGROUND

The popularity of genital cosmetic procedures in women is increasing. These procedures are often assumed and promoted as having a positive effect on women's psychological well-being, particularly their self-esteem. Empirical support for these claims is lacking.

OBJECTIVES

The aim of this study was to conduct a systematic review and meta-analysis of the impact of genital cosmetic procedures on self-esteem in women.

METHODS

The authors performed a systematic literature review of MEDLINE, PreMEDLINE, Ebase, EMBASE, OVID, CINAHL, Cochrane, PsycINFO, and PubMed to identify articles that measured self-esteem in women after a genital cosmetic procedure. A meta-analysis was conducted to assess the pooled effect of these procedures on self-esteem.

RESULTS

The authors identified 5 eligible studies for the meta-analysis, comprising 2 prospective and 3 retrospective studies. Labia minora reduction was the most commonly studied procedure. All 5 studies used different measures of self-esteem, with only 1 study employing a validated psychometric measure at both preoperative and postoperative time points. The meta-analysis results showed a pooled logit rate estimate of 1.230, indicating a positive effect of surgery on self-esteem. However, there was substantial heterogeneity across studies.

CONCLUSIONS

Female genital cosmetic procedures, particularly labiaplasty, appear to have a positive effect on women's self-esteem. However, inconsistencies in study measures and methods limit our conclusions. Future research should involve the development of standardized outcome measures to more accurately assess the impact of these procedures on self-esteem, and on psychological well-being more generally.

LEVEL OF EVIDENCE: 3

Assessing Unrealistic Expectations in Clients Undertaking Minor Cosmetic Procedures: The Development of the Aesthetic Procedure Expectations Scale

Objective: To develop and validate a novel patient-reported measure to assess internally and externally driven expectations for change after a cosmetic procedure, termed the aesthetic procedure expectations (ASPECT) scale. Method: In total, 186 adults recruited from nonsurgical cosmetic clinics in Melbourne, Australia, accessed an online survey (150 completed; 81% response rate) including the novel ASPECT questionnaire, demographics, and measures of psychological distress. Results: The final sample included 141 women and 5 men with a mean age of 44.78 years (standard deviation = 11.68) with <10% missing data. Results supported a two-factor ASPECT scale measuring intrinsic and extrinsic expectations, with high internal consistency and convergent validity. Heightened extrinsic and intrinsic expectations were both associated with individuals who were emotionally distressed, younger, and had previously undertaken more cosmetic procedures. Cutoff scores for the ASPECT subscales are proposed to aid cosmetic practitioners in identifying clients requiring further assessment. Conclusions: The ASPECT scale may provide a reliable and useful clinical tool for cosmetic practitioners to assess unrealistic expectations and determine which clients may require more in-depth consultation before undergoing surgical or nonsurgical cosmetic treatment.

Body Image Quality of Life Inventory: cross-national study in college students from four different countries

PURPOSE

This study was aimed to examine the psychometric proprieties of the Body Image Quality of Life Inventory (BIQLI) among Brazilian, Portuguese, Mozambican, and Italian college students.

METHODS

A total of 1630 subjects (Brazilians = 446; Portuguese = 480, Mozambicans = 360, and Italians = 344) completed the Portuguese (Brazilian, Portuguese, and Mozambican students) and the Italian versions (Italian students) of the BIQLI for measuring the effects of body image on one's quality of life. Psychometric testing included confirmatory factor analysis (CFA), discriminant and convergent validity, internal consistency, and composite reliability. The cross-national invariance of the BIQLI was assessed by multi-group analysis using ΔCFI. Moreover, the global score of the BIQLI for all countries was calculated by an algorithm and compared using the Welch's ANOVA and the Games-Howell post-test (α = 5%).

RESULTS

CFA showed an inadequate fit of unifactorial model of the BIQLI. Therefore, an alternative model comprising nine first-order factors and one second-order factor was proposed and evaluated. This new model showed adequate fit in all samples, despite some limitations that were found with respect to its convergent and discriminant validity. The alternative BIQLI model was invariant among countries. Global scores for the influence of body image on quality of life were significantly different across countries, with the Italians presenting the lowest scores.

CONCLUSIONS

The BIQLI factorial model found in this study represents a reliable and valid alternative to its original structure for the assessment of the effect of body image on college students' perceived quality of life. This model must be further tested in other populations.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

Exploring the Links Between Self-Compassion, Body Dissatisfaction, and Acceptance of Cosmetic Surgery in Young Italian Women

This study aimed to examine the association between positive (self-kindness, common humanity, and mindfulness) and negative (isolation, self-judgment, and over-identification) components of self-compassion, and both body dissatisfaction and acceptance of cosmetic surgery among women, through the mediation (for the negative components) of internalization and physical appearance comparison. The participants were 220 young Italian women aged 19–31 (M = 21) years, who completed a questionnaire assessing the variables of interest. Path analysis indicated that higher mindfulness was directly linked to lower acceptance of cosmetic surgery. Mindfulness presented the strongest link with cosmetic surgery, as it was directly associated with acceptance of cosmetic surgery for both social and interpersonal motivations and with consideration of undergoing some cosmetic procedures. Common humanity and self-kindness were related to acceptance of cosmetic surgery for social reasons. Over-identification seemed to be associated with body dissatisfaction and acceptance of cosmetic surgery both directly and indirectly through internalization and physical appearance comparison. Self-judgment and isolation did not present a significant association with either body dissatisfaction or acceptance of cosmetic surgery. These findings confirm that psychological assessment of women who are interested in cosmetic surgery is highly recommended. Interventions should not consider self-compassion as a whole, but they should rather focus on some of its components. The role of over-identification seems to be especially pivotal, as higher scores on this dimension are linked to higher levels of body dissatisfaction and greater acceptance of cosmetic surgery.

Nonsurgical Management of Facial Masculinization and Feminization

BACKGROUND

Transgender patients may seek nonsurgical methods for facial masculinization and feminization as an adjunct or alternative to undergoing surgical procedures.

OBJECTIVES

The authors reviewed the existing literature regarding this topic and provided an overview of nonsurgical techniques for facial masculinization and feminization.

METHODS

A comprehensive literature search of the PubMed and MedLine databases was conducted for studies published through December 2017 for techniques and outcomes of nonsurgical facial masculinization and feminization. Keywords were used in performing the search. Data on techniques, outcomes, complications, and patient satisfaction were collected.

RESULTS

Four articles fit our inclusion criteria. Given the lack of published literature describing facial injectables in transgender patients, data from the literature describing techniques in cisgender patients were utilized to supplement our review.

CONCLUSIONS

Facial feminization can be achieved through injectables such as neurotoxin and fillers for lateral brow elevation, lip augmentation, malar augmentation, and improvement of rhytids. Facial masculinization can be achieved with injectables used for genioplasty, jawline augmentation, and supraorbital ridge augmentation. One must develop best practices for these techniques in the transgender patient population and increase awareness regarding nonsurgical options.

LEVEL OF EVIDENCE: 4