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Aesthet Surg J. 2016 Oct;36(9):1068-78. doi: 10.1093/asj/sjw078. Epub 2016 May 24.

Self-Report Scales to Measure Expectations and Appearance-Related Psychosocial Distress in Patients Seeking Cosmetic Treatments.

Author information

Dr Klassen is an Associate Professor, Department of Pediatrics, and Associate Member, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. Dr Cano is the Chief Scientific Officer of Modus Outcomes, Boston, MA. Dr Alderman is a plastic surgeon in private practice in Alpharetta, GA. Mr East is a Facial Plastic Surgeon in the Craniofacial Service, University College London Hospitals, and an Honorary Senior Lecturer, University College London Hospitals, London, UK. Ms Badia is a facial plastic surgeon in private practice in London, UK. Dr Baker is a Professor and Program Director, Department of Plastic Surgery, Medstar Georgetown University Hospital, Washington, DC. Dr Robson is a physician in private practice in Aberdeen, Scotland. Dr Pusic is a Plastic Surgeon and Associate Professor, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY.



The use of screening scales in cosmetic practices may help to identify patients who require education to modify inappropriate expectations and/or psychological support.


To describe the development and validation of scales that measure expectations (about how one's appearance and quality of life might change with cosmetic treatments) and appearance-related psychosocial distress.


The scales were field-tested in patients 18 years and older seeking facial aesthetic or body contouring treatments. Recruitment took place in clinics in the United States, United Kingdom, and Canada between February 2010 and January 2015. Rasch Measurement Theory (RMT) analysis was used for psychometric evaluation. Scale scores range from 0 to 100; higher scores indicate more inappropriate expectations and higher psychosocial distress.


Facial aesthetic (n = 279) and body contouring (n = 90) patients participated (97% response). In the RMT analysis, all items had ordered thresholds and acceptable item fit. Person Separation Index and Cronbach alpha values were 0.88 and 0.92 for the Expectation scale, and 0.81 and 0.89 for the Psychosocial Distress scale respectively. Higher expectation correlated with higher psychosocial distress (R = 0.40, P < .001). In the facial aesthetic group, lower scores on the FACE-Q Satisfaction with Appearance scale correlated with higher expectations (R = -0.27, P = .001) and psychosocial distress (R = -0.52, P < .001). In the body contouring group, lower scores on the BODY-Q Satisfaction with Body scale correlated with higher psychosocial distress (R = -0.31, P = .003). Type of treatment and marital status were associated with scale scores in multivariate models.


Future research could examine convergent and predictive validity. As research data are accumulated, norms and interpretation guidelines will be established.


2 Risk.

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