Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 May 6;1(2):ojz015.
doi: 10.1093/asjof/ojz015. eCollection 2019 Jun.

The Psychological Impacts of Upper Facial Lines: A Qualitative, Patient-Centered Study

Steven Dayan  1 , Steven G Yoelin  2 , Koenraad De Boulle  3 , Julie K Garcia  4
Affiliations

The Psychological Impacts of Upper Facial Lines: A Qualitative, Patient-Centered Study

Steven Dayan et al. Aesthet Surg J Open Forum. .

Abstract

Background: The 11-item Facial Line Outcomes (FLO-11) questionnaire is content validated for measuring the negative psychological impacts of crow's feet lines (CFL).

Objectives: The aims of this study were to determine psychological impacts of forehead lines (FHL) alone and upper facial lines (UFL: FHL + CFL + glabellar lines [GL]) and to assess adequacy of FLO-11 to measure these impacts.

Methods: Participants aged at least 18 years participated in concept elicitation and cognitive interviews to identify and define psychological impacts of UFL. They completed the FLO-11 questionnaire to assess its ability to measure psychological impacts of facial lines and its comprehensiveness in doing so.

Results: Forty interviews were completed by 29 participants. Twenty participants each provided interviews for FHL and for UFL. The most commonly reported psychological impacts for FHL and UFL, respectively, were feeling unattractive (85%, 80%), looking less attractive than desired (85%, 70%), feeling bothered (80%, 70%), feeling good/bad about appearance (80%, 70%), looking older than actual age (75%, 65%), and feeling stressed (70%, 70%). For FHL, 70% of participants also reported looking older than desired as a psychological impact. More than 50% of participants agreed that all 11 FLO-11 items measured a psychological impact for FHL. More than 50% reported that 9 of 11 items measured a psychological impact for UFL. The majority of participants (FHL, 65%; UFL, 60%) reported that the FLO-11 questionnaire is comprehensive in measuring psychological impacts of facial lines.

Conclusions: FHL and UFL have psychological impacts on patients, and FLO-11 is a content valid, comprehensive instrument for measuring them.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Study design and interview number and distribution for forehead lines and upper facial lines. FHL, forehead lines; UFL, upper facial lines.
Figure 2.
Figure 2.
Participant-reported impacts of forehead lines (concept elicitation phase), reported by at least 25% of participants.
Figure 3.
Figure 3.
Participant-reported impacts of upper facial lines (concept elicitation phase), reported by at least 25% of participants.
Figure 4.
Figure 4.
Forehead lines: participant-reported impacts of FLO-11 items (cognitive interview phase). Items identified by more than 50% of participants.
Figure 5.
Figure 5.
Upper facial lines: participant-reported impacts of FLO-11 items (cognitive interview phase). Items identified by more than 50% of participants.
See this image and copyright information in PMC

References

    1. Koblenzer CS. Psychologic aspects of aging and the skin. Clin Dermatol. 1996;14:171-177. - PubMed
    1. Dimberg U. Facial reactions to fear-relevant and fear-irrelevant stimuli. Biol Psycshol. 1986;23:153-161. - PubMed
    1. Ekman P. Facial expressions of emotion: an old controversy and new findings. Philos Trans R Soc Lond B Biol Sci. 1992;335:63-69. - PubMed
    1. Adams RB Jr., Nelson AJ, Soto JA, Hess U, Kleck RE. Emotion in the neutral face: A mechanism for impression formation? Cogn Emot. 2012;26:431-441. - PMC - PubMed
    1. Rossi A, Eviatar J, Green JB, et al. . Signs of facial aging in men in a diverse, multinational study: Timing and preventive behaviors. Dermatol Surg. 2017;43(Suppl 2):S210-S220. - PubMed

LinkOut - more resources