COPY permission REVIEW without · 15 years older I look 15 years younger REVIEW COPY Do not use without permission. FACE-QTM - AGING APPRAISAL - Canada-United Kingdom-United States/English

FACE-QTM - PATIENT-PERCEIVED AGE VISUAL ANALOGUE SCALE - Canada-United Kingdom-United States/English – Original version FACE-Q_QOL - Age Appraisal-Visual Analog Scale_AU2.0_eng-CA-GB-USori.docx

FACE‐QTM ‐ PATIENT‐PERCEIVED AGE VISUAL ANALOGUE SCALE

We would like to know how old you think you look. How many years younger or older do you think you look compared with your actual age? Please circle one number below:

-15 -14 -13 -12 -11 -10 -9 -8 -7 -6 -5 -4 -3 -2 -1 0 +1 +2 +3 +4 +5 +6 +7 +8 +9 +10 +11 +12 +13 +14 +15

FACE‐QTM ©2013 Memorial Sloan‐Kettering Cancer Center. All rights reserved.

Psychometric Paper: Panchapakesan V, Klassen AF, Cano SJ, Scott AM, Pusic AL. Development and Psychometric Evaluation of the FACE‐Q Aging Appraisal Scale and Patient‐Perceived Age Visual Analog Scale. Aesthetic Facial Surgery. 2013 Nov 1;33(8):1099‐109.

I look my age

I look 15 years

older

I look 15 years younger

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FACE-QTM - AGING APPRAISAL - Canada-United Kingdom-United States/English – Original version FACE-Q_QOL - Aging Appearance Appraisal SCORING_AU2.0_eng-CA-GB-USori.docx

FACE‐QTM ‐ AGING APPRAISAL For each statement, circle only one answer. These statements ask about how you look right now. We would like to know how you feel about the age your face looks. Please indicate how much you agree or disagree with each statement.

Definitely

disagree

Somewhat

disagree

Somewhat

agree

Definitely

agree

a. I look so old that I don’t recognize myself. 1 2 3 4

b. When I look in the mirror, I don’t look like

myself. 1 2 3 4

c. I am bothered by how old I look. 1 2 3 4

d. I look older than I want to look. 1 2 3 4

e. I am worried by how old I am starting to

look. 1 2 3 4

f. In recent photos, I look older than I want to. 1 2 3 4

g. When I see my reflection, I am reminded of

how old I look. 1 2 3 4


Psychometric Paper: Panchapakesan V, Klassen AF, Cano SJ, Scott AM, Pusic AL. Development and Psychometric Evaluation of the FACE‐Q Aging Appraisal Scale and Patient‐Perceived Age Visual Analog Scale. Aesthetic Facial Surgery. 2013 Nov 1;33(8):1099‐109.

Electronic versions of FACE‐Q scales with scoring are available for Excel and REDCap (http://projectredcap.org/). Contact [email protected] for more information. REVIE

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FACE-QTM - AGING APPRAISAL - Canada-United Kingdom-United States/English – Original version FACE-Q_QOL - Aging Appearance Appraisal SCORING_AU2.0_eng-CA-GB-USori.docx

FACE‐QTM ‐ AGING APPRAISAL CONVERSION TABLE Instructions: Ensure the data are rescored as follows: “Definitely disagree” = 4; “Somewhat disagree” = 3; “Somewhat agree” = 2; “Definitely agree” = 1. Higher scores reflect a better outcome. If missing data is less than 50% of the scale’s items, insert the mean of the completed items. Use the Conversion Table below to convert the raw scale summed score into a score from 0 (worst) to 100 (best).

SUM SCORE EQUIVALENT RASCH TRANSFORMED SCORE (0‐100) 7 0

8 7

9 15

10 21

11 26

12 30

13 35

14 38

15 42

16 46

17 50

18 53

19 56

20 60

21 63

22 66

23 70

24 73

25 77

26 83

27 90

28 100

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FACE-QTM - APPEARANCE-RELATED PSYCHOSOCIAL DISTRESS - Canada-United Kingdom-United States/English – Original version FACE-Q_QOL - Appearance-Related Psychosocial Distress SCORING_AU2.0_eng-CA-GB-USori.docx

FACE‐QTM ‐ APPEARANCE-RELATED PSYCHOSOCIAL DISTRESS For each statement circle only one answer. These are statements people might use to describe themselves. With your appearance in mind, how much do you disagree or agree with each statement:

Definitely

disagree

Somewhat

disagree

Somewhat

agree

Definitely

agree

a. I feel unhappy about how I look. 1 2 3 4

b. I feel stressed about how I look. 1 2 3 4

c. I feel down about how I look. 1 2 3 4

d. I feel anxious when people look at me. 1 2 3 4

e. I worry that I don’t look normal. 1 2 3 4

f. I worry that I am ugly. 1 2 3 4

g. I tend to avoid being around people. 1 2 3 4

h. I have little interest in doing things. 1 2 3 4


Psychometric Paper: Klassen AF, Cano SJ, Alderman A, East C, Badia L, Baker SB, Robson S, Pusic AL. Self‐report scales to measure expectations and appearance‐related psychosocial distress in patients seeking cosmetic treatments. Aesth Plast Surg. 2016 May 24. [Epub ahead of print]

Electronic versions of FACE‐Q scales with scoring are available for Excel and REDCap (http://projectredcap.org/). Contact [email protected] for more information.

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FACE-QTM - APPEARANCE-RELATED PSYCHOSOCIAL DISTRESS - Canada-United Kingdom-United States/English – Original version FACE-Q_QOL - Appearance-Related Psychosocial Distress SCORING_AU2.0_eng-CA-GB-USori.docx

FACE‐QTM ‐ APPEARANCE-RELATED PSYCHOSOCIAL DISTRESS CONVERSION TABLE

Instructions: Higher scores reflect more appearance‐related psychosocial distress. If missing data is less than 50% of the scale’s items, insert the mean of the completed items. Use the Conversion Table below to convert the raw summed scale score into a score from 0 (worst) to 100 (best).

SUM SCORE EQUIVALENT RASCH TRANSFORMED SCORE (0‐100)

8 0

9 3

10 13

11 20

12 26

13 31

14 35

15 39

16 42

17 45

18 47

19 50

20 52

21 54

22 57

23 59

24 61

25 64

26 67

27 70

28 73

29 77

30 82

31 90

32 100

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FACE-QTM - EARLY LIFE IMPACT OF TREATMENT - Canada-United Kingdom-United States/English – Original version FACE-Q_QOL - Early Life Impact of Treatment SCORING_AU2.0_eng-CA-GB-USori.docx

FACE‐QTM ‐ EARLY LIFE IMPACT OF TREATMENT For each question, circle only one answer. These questions ask about recovery from your surgery or procedure. With your most recent facial surgery or procedure in mind, in the past 2 days, how often have you:

Not at all

Some of the

time Most of the

time

a. Felt regret about the surgery or procedure? 1 2 3

b. Felt more anxious than usual? 1 2 3

c. Had trouble sleeping? 1 2 3

d. Wondered if the surgery or procedure was worthwhile?

1 2 3

e. Felt more tired than usual? 1 2 3

f. Avoided certain head movements (e.g. bending your head down)?

1 2 3

g. Not done your usual day‐to‐day activities (e.g. going to work, running errands)?

1 2 3

h. Avoided certain facial movements (e.g. laughing, squinting)?

1 2 3

i. Had difficulty drinking? 1 2 3

j. Had difficulty eating? 1 2 3

k. Avoided social situations? 1 2 3

l. Avoided intimacy (e.g. kissing or hugging)? 1 2 3


Psychometric Paper: 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;135(2):375‐86


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FACE-QTM - EARLY LIFE IMPACT OF TREATMENT - Canada-United Kingdom-United States/English – Original version FACE-Q_QOL - Early Life Impact of Treatment SCORING_AU2.0_eng-CA-GB-USori.docx

FACE‐QTM ‐ EARLY LIFE IMPACT OF TREATMENT CONVERSION TABLE Instructions: Ensure the data are rescored as follows: “Not at all” = 3; “Some of the time” = 2; “Most of the time” = 1. Higher scores reflect a better outcome. If missing data is less than 50% of the scale’s items, insert the mean of the completed items. Use the Conversion Table below to convert the raw scale score into a score from 0 (worst) to 100 (best).

SUM SCORE EQUIVALENT RASCH TRANSFORMED SCORE (0‐100) 12 0

13 7

14 16

15 22

16 26

17 30

18 34

19 37

20 40

21 43

22 46

23 49

24 51

25 54

26 56

27 58

28 61

29 64

30 66

31 70

32 73

33 77

34 82

35 90

36 100

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1 FACE-QTM – EXPECTATIONS - Canada-United Kingdom-United States/English – Original version FACE-Q_QOL - Expectations SCORING_AU2.0_eng-CA-GB-USori.docx

FACE‐QTM – EXPECTATIONS

For each statement circle only one answer. These are statements people might use to describe how their life will change after a cosmetic procedure. With your appearance in mind, how much do you disagree or agree with each statement:

Definitely

disagree

Somewhat

disagree

Somewhat

agree

Definitely

agree

a. I will look fantastic. 1 2 3 4

b. People will tell me how great I look. 1 2 3 4

c. People close to me will be proud of how I look. 1 2 3 4

d. I will be transformed. 1 2 3 4

e. Good things will happen to me. 1 2 3 4

f. I will feel like I fit in. 1 2 3 4

g. My close relationships will improve. 1 2 3 4

h. New people will want to get to know me. 1 2 3 4


Psychometric Paper: Klassen AF, Cano SJ, Alderman A, East C, Badia L, Baker SB, Robson S, Pusic AL. Self‐report scales to measure expectations and appearance‐related psychosocial distress in patients seeking cosmetic treatments. Aesth Plast Surg. 2016 May 24. [Epub ahead of print]


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2 FACE-QTM – EXPECTATIONS - Canada-United Kingdom-United States/English – Original version FACE-Q_QOL - Expectations SCORING_AU2.0_eng-CA-GB-USori.docx

FACE‐QTM – EXPECTATIONS CONVERSION TABLE

Instructions: Higher scores reflect higher (more unrealistic) expectations. If missing data is less than

50% of the scale’s items, insert the mean of the completed items. Use the Conversion Table below to

convert the raw summed scale score into a score from 0 (worst) to 100 (best).


8 0

9 11

10 18

11 23

12 28

13 32

14 35

15 38

16 40

17 43

18 45

19 47

20 50

21 52

22 54

23 57

24 59

25 62

26 65

27 69

28 73

29 77

30 83

31 90

32 100

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FACE-QTM - PSYCHOLOGICAL FUNCTION - Canada-United Kingdom-United States/English – Original version FACE-Q_QOL - Psychological Function SCORING_AU2.0_eng-CA-GB-USori.docx

FACE‐QTM ‐ PSYCHOLOGICAL FUNCTION

For each statement, circle only one answer. These are statements people might use to describe themselves. With your facial appearance in mind, in the past week, how much would you agree or disagree with each statement:

Definitely

disagree

Somewhat

disagree

Somewhat

agree

Definitely

agree

a. I like myself. 1 2 3 4

b. I feel positive about myself. 1 2 3 4

c. I feel okay about myself. 1 2 3 4

d. I feel happy. 1 2 3 4

e. I am comfortable with myself. 1 2 3 4

f. I am accepting of myself. 1 2 3 4

g. I feel good about myself. 1 2 3 4

h. I feel confident. 1 2 3 4

i. I feel attractive. 1 2 3 4

j. I feel great about myself. 1 2 3 4


Psychometric Paper: 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;135(2):375‐86.


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FACE-QTM - PSYCHOLOGICAL FUNCTION - Canada-United Kingdom-United States/English – Original version FACE-Q_QOL - Psychological Function SCORING_AU2.0_eng-CA-GB-USori.docx

FACE‐QTM ‐ PSYCHOLOGICAL FUNCTION CONVERSION TABLE

Instructions: Higher scores reflect a better outcome. If missing data is less than 50% of the scale’s

items, insert the mean of the completed items. Use the Conversion Table below to convert the raw

summed scale score into a score from 0 (worst) to 100 (best).


10 0

11 12

12 16

13 20

14 23

15 25

16 27

17 30

18 32

19 34

20 36

21 38

22 40

23 42

24 45

25 47

26 50

27 52

28 55

29 58

30 62

31 65

32 68

33 71

34 74

35 77

36 80

37 84

38 88

39 93

40 100

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FACE-QTM - RECOVERY EARLY SYMPTOMS - Canada-United Kingdom-United States/English – Original version FACE-Q_QOL - Recovery Early Symptoms_AU2.0_eng-CA-GB-USori.docx

FACE‐QTM ‐ RECOVERY EARLY SYMPTOMS

For each question, circle only one answer. These questions ask about recovery from your surgery or procedure. With your face in mind, in the past 2 days, how much have you been bothered by:

Not at all A little Moderately Extremely

a. Swelling? 1 2 3 4

b. Tenderness? 1 2 3 4

c. Discomfort? 1 2 3 4

d. Feeling bruised? 1 2 3 4

e. Feeling sore? 1 2 3 4

f. Feeling that your face is tight? 1 2 3 4

g. Pain? 1 2 3 4

h. Numbness (loss of feeling)? 1 2 3 4

i. Stinging? 1 2 3 4

j. Tingling? 1 2 3 4

k. Throbbing? 1 2 3 4

l. Burning? 1 2 3 4

m. Feeling tired? 1 2 3 4

n. Itching? 1 2 3 4

o. Feeling lightheaded? 1 2 3 4

p. Headaches? 1 2 3 4

q. Feeling feverish? 1 2 3 4




SCORING: This checklist of symptoms can be scored by adding items to obtain the total number of adverse effects experienced.

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FACE-QTM - SATISFACTION WITH DECISION - Canada-United Kingdom-United States/English – Original version FACE-Q_QOL - Satisfaction with Decision SCORING_AU2.0_eng-CA-GB-USori.docx

FACE‐QTM ‐ SATISFACTION WITH DECISION

For each statement, circle only one answer. We would like to know how you feel about your decision to have your most recent procedure. Please indicate how much you agree or disagree with each statement.

Definitely

disagree

Somewhat

disagree

Somewhat

agree

Definitely

agree

a. It was worth the time and effort. 1 2 3 4

b. It was money well spent. 1 2 3 4

c. It was just what I wanted. 1 2 3 4

d. It was just what I needed. 1 2 3 4

e. It made me look how I want to look. 1 2 3 4

f. It changed my life for the better. 1 2 3 4

FACE‐QTM ©2013 Memorial Sloan‐Kettering Cancer Center. All rights reserved. Psychometric Paper: 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;135(2):375‐86


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FACE-QTM - SATISFACTION WITH DECISION - Canada-United Kingdom-United States/English – Original version FACE-Q_QOL - Satisfaction with Decision SCORING_AU2.0_eng-CA-GB-USori.docx

FACE‐QTM ‐ SATISFACTION WITH DECISION CONVERSION TABLE

Instructions: Higher scores reflect a better outcome. If missing data is less than 50% of the scale’s items, insert the mean of the completed items. Use the Conversion Table below to convert the raw scale summed score into a score from 0 (worst) to 100 (best).

SUM SCORE EQUIVALENT RASCH TRANSFORMED SCORE (0‐100) 6 0 7 15 8 21 9 26 10 30 11 34 12 38 13 41 14 44 15 48 16 51 17 55 18 59 19 64 20 69 21 75 22 82 23 90 24 100

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FACE-QTM - SATISFACTION WITH OUTCOME - Canada-United Kingdom-United States/English – Original version FACE-Q_QOL - Satisfaction with Outcome SCORING_AU2.0_eng-CA-GB-USori.docx

FACE‐QTM ‐ SATISFACTION WITH OUTCOME

For each statement, circle only one answer. We would like to know how you feel about your most recent procedure. Please indicate how much you agree or disagree with each statement.

Definitely

disagree

Somewhat

disagree

Somewhat

agree

Definitely

agree

a. I am pleased with the result. 1 2 3 4

b. The result turned out great. 1 2 3 4

c. The result was just as I expected. 1 2 3 4

d. I am surprised at how good I look in the

mirror. 1 2 3 4

e. The result is fantastic. 1 2 3 4

f. The result is miraculous. 1 2 3 4




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FACE-QTM - SATISFACTION WITH OUTCOME - Canada-United Kingdom-United States/English – Original version FACE-Q_QOL - Satisfaction with Outcome SCORING_AU2.0_eng-CA-GB-USori.docx

FACE‐QTM ‐ SATISFACTION WITH OUTCOME CONVERSION TABLE

Instructions: Higher scores reflect a better outcome. If missing data is less than 50% of the scale’s items, insert the mean of the completed items. Use the Conversion Table below to convert the raw scale summed score into a score from 0 (worst) to 100 (best).


6 0

7 19

8 24

9 28

10 31

11 35

12 38

13 41

14 45

15 48

16 52

17 55

18 59

19 63

20 68

21 73

22 79

23 87

24 100 REVIE

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FACE-QTM - SOCIAL FUNCTION - Canada-United Kingdom-United States/English – Original version FACE-Q_QOL - Social Function SCORING_AU2.0_eng-CA-GB-USori.docx

FACE‐QTM ‐ SOCIAL FUNCTION

For each statement, circle only one answer. These are statements people might use to describe themselves. With your facial appearance in mind, in the past week, how much would you agree or disagree with the each statement:

Definitely

disagree

Somewhat

disagree

Somewhat

agree

Definitely

agree

a. I make a good first impression. 1 2 3 4

b. I feel confident when I meet a new person. 1 2 3 4

c. I am comfortable meeting new people. 1 2 3 4

d. It is easy for me to make new friends. 1 2 3 4

e. I feel confident when I participate in group

situations (e.g. meetings). 1 2 3 4

f. I feel confident in new social situations (e.g.

parties). 1 2 3 4

g. I am relaxed around people that I don’t know

well. 1 2 3 4

h. I feel confident when I walk into a room full of

people I don’t know. 1 2 3 4




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FACE-QTM - SOCIAL FUNCTION - Canada-United Kingdom-United States/English – Original version FACE-Q_QOL - Social Function SCORING_AU2.0_eng-CA-GB-USori.docx

FACE‐QTM ‐ SOCIAL FUNCTION CONVERSION TABLE

Instructions: Higher scores reflect a better outcome. If missing data is less than 50% of the scale’s

items, insert the mean of the completed items. Use the Conversion Table below to convert the raw

scale summed score into a score from 0 (worst) to 100 (best).


8 0

9 8

10 14

11 19

12 24

13 28

14 31

15 35

16 38

17 41

18 44

19 46

20 49

21 52

22 55

23 58

24 62

25 66

26 70

27 73

28 77

29 81

30 86

31 92

32 100

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Documents

COPY permission REVIEW without · 15 years older I look 15 years younger REVIEW COPY Do not use without permission. FACE-QTM - AGING APPRAISAL - Canada-United Kingdom-United States/English