American Society of Plastic Surgeons
For Medical Professionals

ASPS Recommends the Use of Plastic Surgery Specific Patient-Reported Outcome Measures

David Song, MD, MBA, President of The American Society of Plastic Surgeons responds to an article in the Journal of the American Medical Association – Facial Plastic Surgery, that discusses the correlation between facelift and patients' self-esteem.

Dear Dr. Rhee,

I read with concern the JAMA Facial Plastic Surgery's recently published study published October 29, 2015 entitled: "Association of Patient Self esteem With Perceived Outcome After Facelift Surgery" authored by Andrew Jacono and colleagues [1].

As President of The American Society of Plastic Surgeons (ASPS), I applaud research conducted to measure plastic surgery patient outcomes. The measurement of patients' psychological response to treatment is indeed valuable and critical to the continuous improvement of our surgical techniques and outcomes. In this case, however, I find the use of the Rosenberg Self-Esteem scale, the research tool on which the conclusions drawn from this study are based, troubling. To obtain data from a scale developed in 1965 in a sample of adolescents is inappropriate and unnecessary, given the fact that sophisticated and precise measurement tools have now been developed for plastic surgery patients, and are being utilized with great success.

Over the past decade, standards and guidelines for the use and development of PROMs (Patient Reported Outcome Measures) have been established by international experts and regulatory bodies [1-2]. A key issue in selecting a PROM for a given study is the assessment of whether or not the measurement tool is valid in the study population in which it is being used. In a study of facial aesthetic outcomes, the use of a PROM developed to measure the concerns of adolescents is less than ideal and possibly misleading, as the content for that scale was not developed with input from facial cosmetic surgery patients. A lack of content validity could be why the Rosenberg scale failed to detect important quality of life changes in an aesthetic surgery sample.

The ASPS and The Plastic Surgery Foundation have a long-standing commitment to measuring and tracking patient-reported outcomes on facial aesthetic patients. In the selection of PROMs, we are committed to using scales that provide meaningful and clinically relevant data. The FACE-Q [4-5] is a PROM designed for facial aesthetic patients and in accordance with current guidelines [2-3]. Studies using the FACE-Q are providing important evidence about facial aesthetic procedures outcomes, including the positive impact treatments can have on quality of life.

With the transparency of clinical research and the sophistication of healthcare consumers, the reporting of meaningful and relevant data that may affect one's aesthetic care decisions and their confidence in our specialty is crucial. The ASPS thus recommends our community use PROMs that are in line with current standards for quality of life measurement.


David Song, MD, MBA

  1. Jacono A, Chastant RP, Dibelius G. Association of patient self-esteem with perceived outcome after face-lift surgery. Facial Plast Surg. Oct 29, 2015. Epub ahead of print.
  2. UCM370175.pdf Accessed 17 Nov 2015.
  3. Accessed 17 Nov 2015.
  4. Pusic A, Klassen AF, Scott AM, Cano SJ. Development and psychometric evaluation of the FACE-Q Satisfaction with Appearance Scale: A new PRO instrument for facial aesthetics patients. Clinics in Plastic Surgery. 2013; 40:249-60
  5. Klassen AF, Cano SJ, Schwitzer J, Scott A, Pusic AL. FACE-Q scales for health-related quality of life, early life impact and satisfaction with outcomes and decision to have treatment: development and validation. Plast Reconstr Surg. 2015 Feb;135(2):375-86

About ASPS

The American Society of Plastic Surgeons (ASPS) is the largest organization of board-certified plastic surgeons in the world. Representing more than 11,000 physician members worldwide, the society is recognized as a leading authority and information source on cosmetic and reconstructive plastic surgery. ASPS comprises more than 92 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the society represents physicians certified by the American Board of Plastic Surgery or the Royal College of Physicians and Surgeons of Canada.

Media Contact

ASPS Media Relations
(847) 228-3333


Patient Care Center