Cosmetic Surgeries: Patient Psychosocial and Quality of Life impact

During her session, “Cosmetic Surgery and its Impact on Quality of Life,” Heidi B. Prather, MD, FAAD, opened with the psychosocial and quality of life impacts commonly seen in cosmetic dermatology, particularly related to acne and pigmentary disorders.

To start, she showcased the psychosocial distress related to acne that is not limited to just adolescents. She shared that chronic skin conditions typically impact anxiety and depression, with 20% to 40% patients with acne susceptible to depression, although rarely with suicidal ideation. Additionally, she shared that about 50% of patients with vitiligo experience negative psychosocial impacts on relationships such as marriage.

To treat acne, Dr Prather suggested minimally invasive options for physicians to consider, such as adjunct treatment with superficial salicylic acid 30%, with or without pulsed dye laser, and phenol 88% chemical reconstruction of skin scars, which is safer and just as effective as trichloroacetic acid.

She continued to present the various quality of life measuring tools typically used in cosmetic dermatology, starting with the general quality of life tools, such as the 36-item Short-Form Health Survey. She then continued to the surgery specific quality of life measuring tools, which consist of the Rhinoplasty Outcomes Evaluation, Facelift Outcomes Evaluation, Blepharoplasty Outcomes Evaluation, and Skin Rejuvenation Outcomes Evaluation. Next, she presented the disease specific quality of life measuring tools, such as the Melasma Quality of Life Scale, Dermatology Life Quality Index, and Skindex-16. Lastly, Dr Prather shared the cosmetic specific quality of life tools by introducing the BeautyQoL questionnaire and FACE-Q.

The BeautyQoL tool is the first international instrument that focuses on specific cosmetic products and physical appearance. Validated in 16 languages, it consists of 42 questions that center around:

• Social life
• Self-confidence
• Mood
• Vitality
• Attractiveness

The FACE-Q aesthetic scales focus on patient-reported outcomes that are specific to aesthetic facial procedures and products. FACE-Q uses a 4-point scale that is summed and converted to a score from 0 to 100, where a higher score typically means a better outcome. There are a total of 39 FACE-Q scales, with 23 on appearance, 10 on health-related quality of life, and 6 on adverse effects.

Next, Dr Prather shared how patients often seek cosmetic procedures to improve their quality of life. In fact, she mentioned that there are 8 themes behind this patient motivation:

• Mental and emotional health
• Physical health
• Work and/or school success
• Social well-being
• Cost and/or convenience
• Procedural perceptions
• Timing of treatment
• Cosmetic appearance

To elaborate, Dr Prather noted that patients are often motivated by physical and psychosocial well-being, such as minimizing self-consciousness, enhancing confidence, reducing time and expense to conceal, and perceiving capabilities.

“This is profound that patients are looking at more than just vanity when they start looking at minimally invasive cosmetic procedures,” she stated.

Finally, Dr Prather shared how the patient impact goes beyond beauty, highlighting a multicenter prospective study that measured the impact of cosmetic treatments. The study showed that about 16% of cohorts felt more attractive following cosmetic treatments, about 15% felt younger, and about 13% reported an improvement in their psychosocial function.

Reference
Prather H. Cosmetic surgery and its impact on quality of life. Presented at: Dermatology Week 2022; September 14-17, 2022; Virtual.