COSMIN database

Outcome measures in facial plastic surgery: patient-reported and clinical efficacy measures

Rhee, J. S. and McMullin, B. T.
OBJECTIVE: To survey the existing literature to identify, summarize, and evaluate procedure- and condition-specific outcome measures for use in facial plastic and reconstructive surgery.

METHODS: A review of the English-language literature was performed to identify outcomes instruments specific for targeted facial plastic surgery interventions and conditions. A search was performed using MEDLINE (1950 to September 2007), CINAHL (Cumulative Index to Nursing & Allied Health) (1982 to September 2007), and PsychINFO (1806 to September 2007). Outcomes instruments were categorized as patient-reported or clinical efficacy measures (observer-reported or objective measures). Instruments were then categorized to include relevant details on the intervention, degree of validation, and subsequent use.

RESULTS: Sixty-eight distinct instruments were identified (23 patient-reported, 35 observer-reported, and 10 objective measures), with some overlap among categories. Most patient-reported measures (76%) and half observer-reported instruments (51%) were developed in the past 10 years. The rigor of validation varied widely among measures, with formal validation being most common among the patient-reported outcome measures.

CONCLUSIONS: Validated outcomes measures are present for many common facial plastic surgery conditions and have become more prevalent during the past decade, especially for patient-reported outcomes. Challenges remain in harmonizing patient-reported, observer-based, and other objective measures to produce standardized clinically meaningful outcome measures.
Arch Facial Plast Surg
1521-2491 (Print)
Publication year:
Biological and physiological variables:
Biological and physiological variables
Symptom status:
Physical state
Functional status:
Physical functioning
Overall quality of life:
Overall quality of life
Adults (18-65)
Children (0-18)
Seniors (65+)
External causes of morbidity and mortality
Factors influencing health status and contact with health services
PRO / non-PRO:
Non-patient Reported Outcome
Patient Reported Outcome
Type of measurement instrument:
1 - Questionnaires
6 - Clinical rating scales
7 - Observations
8 - Imaging tests
9 - Laboratory tests
Adour-Swanson facial nerve grading system
Anthropomorphic soft tissue analysis
Bayramicli nasal defect classification
Bock QoL - Bock Quality of Life Questionnaire for Patients with Keloid and Hypertrophic Scarring
BOE - Blepharoplasty Outcomes Evaluation
Burres-Fisch linear measurement index
Cassileth scar questionnaire
Computer-assisted photographic analysis of rhytidectomy
DAS - Derriford Appearance Scale (versions: DAS-24 - DAS-24 items; DAS-59 - DAS-59 items)
D/D - Dropkin Disfigurement and Dysfunction Scale
DEFS - Detailed Evaluation of Facial Symmetry
DLQI - Dermatology Life Quality Index   
DSHNC - Disfigurement Scale for Head and Neck Cancer
Duncan visual analog scale and scar ranking
Ectropion grading scale
FaCE - Facial Clinimetric Evaluation Scale
Facial halves comparisons
FAST - Facial Appearance Sorting Test
FDI - Facial Disability Index
FGS - Toronto/Sunnybrook Facial Grading System
FLO - Facial Line Outcomes Questionnaire
FOE - Facelift Outcomes Evaluation
FQAD - Freiburg Questionnaire on Aesthetic Dermatology and Cosmetic Surgery
FWS - Facial Wrinkle Scale
GAIS - Global Aesthetic Improvement Scale
Garcia-McCollough scale for lower eyelid appearance
GBI - Glasgow Benefit Inventory
Harmonized profiloplasty
HIV-associated facial lipoatrophy scale
Honeck 4-point clinical severity score for glabellar frown lines
House-Brackmann facial grading questionnaire
House-Brackmann Scale
Hund 4-point clinical severity scores for lateral canthal lines
HWES - Hollander Wound Evaluation Scale
Iowa Repaired Facial Nerve Recovery Scale
Laser mapping of facial soft tissues
Lemperle wrinkle assessment scale of upper-lip lines
MASI - Melasma Assessment Severity Index
May facial nerve grading system
MDACS - Malposition, Distortion, Asymmetry, Contour deformity, and Scar grading scale
MelasQOL - Melasma Quality of Life scale
MoReSS facial nerve grading scale
MSS - Manchester Scar Scale
Nasolabial fold analysis
Nasolabial fold scale
NOSE - Nasal Obstruction Septoplasty Effectiveness
Nottingham facial grading system
Patient-Rated Facial Disfigurement Analogue Scale Questionnaire
Phi Mask Analysis
POSAS - Patient and Observer Scar Assessment Scale   
Quinn visual analog scale
RASP - Rhinoplasty Assessment Scale Photographic
RNKLS - Rated Numeric Kinetic Line Scale
ROE - Rhinoplasty Outcomes Evaluation
SAQ - Synkinesis Assessment Questionnaire
SCI - Skin Cancer Index
Singh botulinum toxin questionnaire
SROE - Skin Rejuvenation Outcomes Evaluation
Stennert facial nerve grading index
Structured light scanning of facial surface
Sydney facial grading system
Three-dimensional digitization of nasal landmarks
Vancouver scale
WSRS - Wrinkle Severity Rating Scale
Yanagihara facial nerve grading system