FACE-Q Questionnaire Research Articles

Strategic management of the minor-form and microform cleft lip: A long-term outcome assessment

The treatment of the lesser form cleft lip deformity (i.e., minor-form, microform, and mini-microform) is challenging to achieve patient satisfaction. There are no studies investigating how treatment outcomes balance patients' expectations and satisfaction with surgical or non-surgical care relative to the initial nasolabial findings. Based on Mulliken's classification, consecutive records of patients with the lesser-form cleft lip from 1990 to 2015 were selected for analysis. Demographics, management, and revisions were reviewed. A panel analysis was performed based on the ratings from both professionals and non-professionals using patients' photographs. FACE-Q questionnaires were used to compare patient/parent-reported satisfaction to the normal controls. A total of 135 patients were included. All of the minor-form (23/23), 89% (58/65) of the microform, and 62% (29/47) of the mini-microform patients underwent surgery. Fifty-two percent (15/29) of the mini-microform patients, who underwent surgery, showed no significant improvement. Post-operative upper lip scars and remaining nasal asymmetry were the most common concerns in the treatment group. However, the FACE-Q results showed that patients experienced a statistically significant improvement in their overall facial appearance and social function in their respective groups. This study showed that differences exist in the perception of facial esthetics between the surgeon and the patient/parent. To achieve optimal individual treatment outcome and patient satisfaction, an awareness of the differences and treatment selection for patients are critical in surgical planning. This understanding and an open detailed discussion of overall long-term outcomes help in the management of patient expectations.

Novel artificial eye service evaluation using patient reported outcome measures.

This service evaluation explores patient reported outcomes from patients provided with high definition ocular prostheses (artificial eyes). Validated patient questionnaires (FACE-Q, DAS24 and HADS) were utilised to evaluate patient experiences of their new ocular prosthesis. 10 patients were included in the service evaluation, which was conducted between December 2018 and September 2019. Descriptive analysis of the mean and 95% CI was undertaken for all questionnaires. Statistical analysis was performed using SPSS 21 Principal Component Analysis (PCA) for FACE-Q questionnaires. Correlations were significant when factor loading is at α > 0.4. A questionnaire response rate of 80% was achieved (n = 8). PCA analysis showed the number of variables tested could be reduced. Two principal components (PC1 and PC2) had very good to excellent internal consistency between variables with factor loading (α = 0.7-0.9). PC1 contained questionnaires 1-7, all of which were highly correlated. PC2 contained question number 8 with a factor loading of α = 0.8. This indicates good reliability, validity and responsiveness. We hope to demonstrate the importance of service evaluations with respect to rapidly evolving technological advances in medical devices, pharmaceuticals and imaging modalities. Further feasibility and full clinical studies are required to confirm the positive results of the novel artificial eye service we have evaluated with respect to the traditional approach.

Patient- and clinician-reported outcomes of lower jaw contouring using patient-specific 3D-printed titanium implants

The main aim of this study was to assess patient-reported outcomes of jawline contouring with patient-specific three-dimensional (3D) -printed titanium alloy implants using validated Face-Q questionnaires. Four FACE-Q questionnaires (Appearance Appraisal Scale, Quality of Life Scales for Psychological and Social Function, and Adverse Effects Scale) were sent to 21 patients consecutively operated on by the same surgeon between 2014 and 2019. Thirteen patients responded. Mean Rasch Transformed Scores for Satisfaction, Psychological Function and Social Function (0–100) were 70.6, 73.2, and 71.1, respectively. These values are difficult to interpret, however, as comparative literature and prospective follow-up scores are lacking. The second objective was to correlate clinician-reported morphology improvement by panel scoring (Likert scale) with patient-reported appearance appraisal. As for satisfaction, we can conclude that an objective acceptable result does not corroborate patients’ perceptions (Spearman Rho test rs = -0.021). Psychological factors and results from previous surgeries probably modulate patients’ views. The mean score for the Adverse Effect Scale (15–45) was low (18.6), indicating that the intraoral drop-in fit of customized titanium implants does not cause major side effects.

Measuring aesthetic results after facial skin cancer surgery by means of the FACE-Q

BackgroundSkin cancer is the most commonly occurring type of cancer. However, the influence of facial skin cancer surgery on patients’ perceived aesthetic appearance is poorly understood. The objective of this study was to provide an insight into how patients perceive the aesthetic outcome of facial skin cancer surgery by means of a specialised patient-reported outcome measure designed for the aesthetic evaluation of the face: the FACE-Q.MethodsA total of 47 patients with non-melanoma skin cancer who were scheduled for Mohs’s micrographic surgery (MMS) or standard surgical excision (SE) were included. These patients filled out three different FACE-Q questionnaires: satisfaction with facial appearance, social function, and satisfaction with outcome. Follow-up was conducted after baseline at 1 month and 3 months post-surgery.ResultsNo significant differences were detected between baseline and follow-up regarding social function and satisfaction with facial appearance. However, after 3 months, patients were significantly more satisfied with the result of surgery when compared with the 1-month post-surgery follow-up.ConclusionsThe perceived aesthetic appreciation of patients does not seem to be significantly influenced by facial skin cancer SE or MMS surgery in this 3-month follow-up study.Level of evidence: Not ratable.

Fat Grafting in Patients With Extensive Unilateral Facial Deficiency: Three-Dimensional Computer-Assisted Planning, Implementation, and Outcome Assessment.

Autologous fat injection is a widely used, simple, and less invasive technique to correct volume deficiency. This study developed a treatment method by using a 3-dimensional (3D) simulation to plan and implement fat injection in patients with an extensive facial deficiency and then validated the accuracy of the method and treatment outcomes. Seven patients with a large unilateral facial deficiency receiving autologous fat grafts between 2015 and 2017 were recruited. One patient received repeated treatment. Furthermore, 3D surgical simulation was used to measure the difference between the mirrored image and lesion side. An extra 20% to 30% of fat graft was added. A color map was provided, and contour lines 2 mm deep marked the location of the fat injection. Outcome assessments were then performed, and a 3D symmetry index was defined using the contour lines on the facial surface. No significant difference was noted between the predicted volume and postoperative fat graft retention (35.7 ± 7.4 and 31.6 ± 9.7 mL, respectively; P = 0.176). A comparison of preoperative (79.5% ± 4.3%) and postoperative (89.0% ± 3.3%) 3D symmetry indexes indicated significantly improved facial symmetry (P = 0.018). Patient-reported outcomes of satisfaction on FACE-Q questionnaires yielded an average score of 62.73, higher than the control score (59.83). By using the proposed method, we could predict the required fat graft volume; moreover, the contoured map aided accurate surgical implementation. Thus, this method is useful for planning and guiding fat grafting treatment in patients with major unilateral facial deficiency.

Face Lifting in Bald Male Patients: New Trends and Specific Needs.

Aesthetic surgery has recently become popular also among men. The ever-increasing number of bald men wishing to undergo facial surgery represents a challenge for the surgeon, as the scars cannot be hidden in the hair and must therefore be as short as possible. The authors present their experience in face lifting in bald male patients and propose an innovative technique to handle the skin excess to achieve practically invisible scars. A 10-year observational study was carried out on 68 bald male face-lift patients. All patients underwent deep plane lifting with a specific method for handling skin excess. This technique is the innovation presented in this article. Subjective and objective methods were used to evaluate the results. The well-known FACE-Q questionnaire was sent to all the patients together with an explanatory letter. Three ad hoc questions were added to the questionnaire to assess the degree of satisfaction with the scars. The objective method involved the evaluation of preoperative and postoperative photographs by a three-member jury. The average follow-up period was 12 months. All patients showed a high degree of satisfaction with the final appearance of the surgical scars and appreciation of the overall quality of the result, 1 year after face-lift surgery. No patient expressed regret about choosing to undergo this type of surgery. Very high scores were registered for the overall facial appearance and for the various critical areas examined, including scars, from patients and experts alike. The face-lifting technique for bald men proposed by the authors, involving a peculiar and innovative way of handling the skin excess, has proven to be reliably effective in obtaining virtually invisible scars.

Safety and Effectiveness of VYC-17.5L for Long-Term Correction of Nasolabial Folds.

Juvéderm Vollure XC (VYC-17.5L; Allergan plc, Dublin, Ireland) belongs to a family of hyaluronic acid gels based on the Vycross technology platform. The authors sought to evaluate the safety and effectiveness of Vollure for correction of moderate to severe nasolabial folds (NLFs) over 18 months and after repeat treatment. In this prospective, randomized study, patients (N = 123) received initial/touch-up treatment with Vollure in 1 NLF and control filler in the contralateral NLF. Patients received optional repeat treatment with Vollure after month 12, 15, or 18. Assessments included investigator-rated NLF Severity Scale responder rates (≥1-point improvement vs baseline), patient-assessed Appraisal of Nasolabial Folds scale of the FACE-Q questionnaire, and patient satisfaction (11-point scale). Median volume of Vollure injected was 1.7 mL for initial/touch-up treatment combined and 0.6 mL for repeat treatment. The NLF Severity Scale responder rates were 93%, 85%, and 59% at months 6, 9, and 18 after initial/touch-up treatment and increased to 94% at 1 month after repeat treatment. Mean patient-reported FACE-Q scores significantly improved from baseline at all timepoints. Most patients were very satisfied with treatment at all timepoints from day 3 (75%) through month 18 (68%) and at 1 month after repeat treatment (94%). Common injection site responses after initial/touch-up and repeat treatment were firmness, swelling, and tenderness to touch; most were mild/moderate. Vollure was safe and effective for correction of moderate to severe NLFs, with results lasting 18 months in 59% of NLFs. Repeat treatment required one-third of the injection volume to achieve similar improvement in NLF severity as initial/touch-up treatment.

Modification of Rhytidectomy: Stepped Lift of the Superficial Musculoaponeurotic System.

Rhytidectomy is a complicated surgery. Less experienced surgeons are often confronted with technical challenges. To simplify the procedure and achieve long-lasting effects, the authors propose a modified rhytidectomy method, reorder surgical sequences and suggest a stepped lift of the superficial musculoaponeurotic system.A total of 54 patients underwent this surgical procedure. Superficial musculoaponeurotic layers of the temple, face, and neck were dissected sequentially and suspended to lift the ptosis tissue. They scored the frontalis and excised the corrugator after raising the flap in the subgaleal plane. The operation time, complication events, drainage volume, and hospital days were compared with conventional surgical technique. Patient-reported outcomes were described using a modified Face-Q questionnaire. Three laypersons evaluated pre- and postoperative pictures.In the current technique, the average operation time was 265 minutes. The total complication rate was 7.40%; only 1 patient with hematoma needed extra treatment. Compared with previous technique, the operating time of current technique shortened, and the drainage volume decreased. Three-year follow-up showed all patients were satisfied with the surgical outcomes and thought they looked 8.3 years younger than their actual age. The areas with greatest satisfaction were midface, temple, and nasolabial folds. Significant improvements were seen comparing pre- and postoperative photos.Follow-up indicated that modified facelift procedure and stepped superficial musculoaponeurotic layer lift technique worked well for elderly patients who have severe facial wrinkles and ptosis, and provide a long-lasting natural and youthful appearance.Level of Evidence: Level IV, therapeutic study.

A 3-Dimensional Quantitative Analysis of Volume Loss Following Submental Cryolipolysis.

Cryolipolysis is a proven and effective means of fat reduction; however, there are no standardized means of measuring volume reduction. We aim to assess the volume loss using a 3-dimensional (3D) analysis following submental cryolipolysis. A retrospective cohort study between April 2016 and August 2018 was performed. Thirty-five patients underwent a single 45-minute cycle of cryolipolysis to the submental region using the CoolSculpting System. A 3-fold analysis was performed employing an independent observer assessment of 2-dimensional photographs and 3D volumetric analysis utilizing the Vectra XT system, and patient satisfaction was measured with the FACE-Q questionnaire. Our results suggested the mean (standard deviation) pretreatment volume (n = 35) was 104.12 cm3 (28.78). The 6-week mean posttreatment volume (n = 26) was 81.55 cm3 (21.29). The mean volume reduction found at 6 weeks posttreatment showed a reduction of 22.46 cm3 (19.10) (95% CI 14.74 to 30.17, P < 0.0001). The 12-week mean posttreatment volume (n = 24) was 82.24 cm3 (23.97). The 12-week posttreatment demonstrated a reduction of 22.30 cm3 (14.04) (95% CI 16.37 to 28.23, P < 0.0001). The mean percentage correct for each reviewer correctly identifying the pretreatment and posttreatment photograph was 76.33% (7.14). Patient satisfaction showed a mean FACE-Q score of 54.10 (20.41). The study further affirms that submental cryolipolysis is an efficacious and safe, noninvasive method for reducing submental adiposity resulting in notable patient satisfaction rates. Furthermore, results suggest that patients can have a volume loss of about 20% on average, allowing them to be more confident and comfortable with their appearance.

Translation, Cross-Cultural Adaptation and Linguistic Validation of the FACE-Q Questionnaire for Brazilian Portuguese.

Patient-reported outcomes measurement instruments (PRO) are a good way to measure results after aesthetic procedures. FACE-Q is a systematized and standardized PRO tool and was not available in Portuguese. This cross-sectional study included four stages: translation of FACE-Q, backtranslation, testing in patients who underwent facial aesthetic procedures and review of the questionnaires between September and December, 2018. Guidelines merging WHO and ISPOR's rules were followed. Translation was conducted by two translators, resulting in two versions, translation A and translation B, which were reconciled to generate the first Portuguese version. Reconciliation showed inconsistencies between TA and TB in 63% (n = 222) of the 353 questions, which were solved by maintaining TA in 25% of cases (n = 87), TB in 27% and a new version in 11% (n = 40) of the questions. Backtranslation showed written differences with the original FACE-Q in 64 (22.7%) of the 353 question, but only one case of semantic difference, which was corrected resulting in production of the second Portuguese version. Seven patients with a mean age of 35.8years were interviewed to assess the difficulty in understanding the questionnaires. Four patients had no or minor difficulties understanding the questionnaire, and the other three had difficulties and suggested changes that led to a third Portuguese version. The third version was reviewed for grammar and spelling resulting in the final Portuguese version. A Brazilian Portuguese version of the FACE-Q questionnaire was obtained maintaining equivalency with the source instrument. This will allow cross-cultural research and comparison of results between different studies. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Thread facelift: Satisfaction rate among the patients using FACE-Q

Objectives: To know the patients’ satisfaction undergoing thread facelift using FACE-Q. Materials and Methods: The study was conducted in a private cosmetic surgery setup in patients undergoing thread facelift. Six different scales of FACE-Q questionnaire were used pre-operatively and after 3 months. All the responses were collected. And the data was analyzed to find out the statistical significance. Results: The FACE-Q was completed by 50 patients. All the patients underwent thread facelift which included barbed sutures and PDO threads. The mean age of the patients was 37.7 years (males: 39.3 years and females: 36.8 years). The patients showed significant changes in the pre-operative and postoperative parameters (p<0.01). Conclusion: The patient-reported outcome instruments like FACE-Q have great implications for ascertaining the outcomes of the cosmetic procedures.

French validation of the FACE-Q Rhinoplasty module.

The aim of this study was to translate the FACE-Q "Rhinoplasty" module into French and validate its use for the French-speaking population. "Satisfaction with the nose" and "Satisfaction with nostrils" questionnaires were used and translated. We were granted permission to use the FACE-Q rhinoplasty module by the development team. These two questionnaires constitute the rhinoplasty module of the FACE-Q questionnaire. ISPOR and WHO recommendations were used to complete the translation process from English into French in six steps. Our goal was to obtain, not a literal translation, but rather a translation of the idea or concept. Each step allowed us to make changes to achieve a conceptual translation equivalent to the original version. The FACE-Q questionnaire is a reference in the field of cosmetic surgery outcome evaluation. The use of two validated translation recommendations, with a six-step translation-back translation process, leads to a French version corresponding to the original. This version is usable in a French-speaking population.

Periauricular Purse-String Reinforced with SMAS plication and Malaria Fat Pad Elevation for Mid-and Lower Facial Rejuvenation: FACE-Q Report.

Facial aging is a complex process influencing every layer of the facial structure. Most accepted surgical techniques for facial rejuvenation involve certain manipulation of the superficial musculoaponeurotic system (SMAS). Out of these SMAS-based techniques, SMAS plication or suspension provides excellent outcomes with shorter convalescence and fewer potential complications. Herein, we would like to present our own technique combining SMAS plication, periauricular purse-string, and malar fat pad elevation technique for mid and lower facelift. Through a classical periauricular and temporal incision, a periauricular permanent purse-string suture was woven into the SMAS to suspend sagging soft tissue of the mid and lower face after superficial undermining, then plication of inner and outer SMAS of the purse-string loop was performed to further secure suspension, and at last the malar fat pad was elevated for midface rejuvenation. The shape of the loop varies with patients' age; for younger patients, the loop is more vertical, and for older patients, the loop is more horizontal. Patient-reported outcomes were described using the FACE-Q questionnaire. From January 2010 to June 2015, a total of 138 patients were treated with this technique by a same surgeon. Follow-up duration ranged from 1 to 6 years. Preoperative and postoperative photographs were recorded and analyzed. The complications rates were low, and satisfaction rates were high. Patients felt that they appeared 7.3 years younger than their actual age on average and were most satisfied with the appearance of their lower face and jawline. Periauricular purse-string reinforced with SMAS plication and malar fat pad elevation technique produces esthetically pleasing outcomes, besides being simple, safe, and personalized.

Satisfaction with Facial Appearance and Quality of Life after Treatment of Face Scars with a Transparent Facial Pressure Mask.

Treatment of facial hypertrophic scars and deformities has developed from the use of elastic fabric hoods to transparent facemasks. The clinical effects of these masks have been described. However, the psychological impact of wearing such a mask is not well documented. The aim of this study was to assess patients' satisfaction with their current facial appearance, to assess the end result of facemask therapy, and to assess the decision to have undergone facemask therapy by means of four different FACE-Q questionnaires. Out of the eligible 87 patients who completed the facemask therapy between January 2012 and November 2017, 42 filled out the questionnaires. These patients wore a custom-fabricated facemask because of facial hypertrophic scars and severe postsurgical facial irregularities. Patients who wore the mask 12 to 16 hours per day were significantly more satisfied with the end result compared with those who wore it 4 to 8 hours daily. Also, patients who wore the mask 8 to 12 and 12 to 16 hours each day were more satisfied to have undergone therapy compared with those who wore it 4 to 8 hours daily. Furthermore, patients who finished therapy 3 to 4 years and 4 to 5 years ago reported a significant higher satisfaction with facial appearance compared with those who completed therapy in a time period shorter than 1 year ago. Patients who finished therapy 3 to 4 years ago reported higher satisfaction with their facial appearance compared with those who finished therapy 2 to 3 years ago. Additionally, the Patient and Observer Scar Assessments Score (POSAS) showed a significant reduction between start and end of therapy. This study shows facemask therapy to result in long-lasting stable results. It also shows a longer daily wearing of the facemask to result in the highest satisfaction according to patients.

The liquid facelift: First hands-on experience with facial water jet-assisted liposuction as an additive technique for rhytidectomy – a case series of 25 patients

Recently, water jet-assisted liposuction (WAL) was successfully applied by several other authors to remove fat and induce skin contraction in nonfacial body areas. Extending the range of indications for this new method, the authors of this article report on their first experience with its use in facial contouring, fat harvesting, and hydrodissection of the facial skin flap in rhytidectomy in a case series of 25 patients. Twenty-five patients (median age: 56 years) had facelift surgery under sedation, and the WAL technique was used for facial contouring, fat harvesting for facial lipotransfer, and hydrodissection of the facial skin flap. Patients were monitored for discomfort during the procedure. Complications such as bleeding, postoperative swelling, and hematoma formation were observed during a 1-week follow-up period, and intensity was rated by two independent surgeons using a special grading system. Furthermore, a patient survey (FACE-Q) was performed to analyze the patients' satisfaction and perception of the postsurgical esthetic results. The WAL technique can be applied under intravenous sedation without causing any discomfort in all treated patients [mean 1.16, standard deviation (SD) 0.31]. Intraoperative bleeding during WAL-assisted facial dissection was judged as not present at all times (mean 1.3, SD 0.32). Postoperative swelling (day 1: mean 1.82, SD 0.28; day 7: mean 1.18, SD 0.28) and hematoma formation following surgery (day 1: mean 1.58, SD 0.34; day 7: mean 1.18, SD 0.31) were judged as minor in all cases. Overall, no skin necrosis was detected. There was no need for revision surgery. More than half of our treated patients (n = 13) answered the FACE-Q questionnaire, verifying a high satisfaction rate with beneficial treatment results without the occurrence of any major complications. The WAL technique seems to offer a safe and efficient treatment approach for facial contouring, facial fat harvesting, and simultaneous facial flap hydrodissection with only minor postoperative swelling and hematoma formation. Therefore, the authors believe that the WAL technique is a powerful and useful tool and should be used in modern facial plastic surgery.

Abstract: Patient Satisfaction after Facial Reconstruction Using the FACE-Q Questionnaires

INTRODUCTION: Patient reported outcomes using the FACE-Q questionnaires have become a useful method to evaluate the effectiveness of aesthetic procedures, such as face lifts, blepharoplasty, and rhinoplasty.1–3 Despite these advancements, patient reported outcomes after facial reconstructive procedures are lacking. This study aims to evaluate the satisfaction of patients undergoing reconstructive procedures after facial trauma. METHODS: Patients treated for facial injuries at R Adams Cowley Shock Trauma Center were asked to complete four FACE-Q questionnaires: 1. Satisfaction with Outcome, 2. Psychological Well-Being, 3. Social Function, and 4. Satisfaction with Medical Team. Each questionnaire was scored from 0 to 100, with higher score indicating greater satisfaction. The mean score for each questionnaire was calculated. Univariate analysis was used to determine differences in satisfaction between patients with significant facial disfigurement and those with none or minimal disfigurement. RESULTS: One hundred nine patients were analyzed, 79 male and 30 female, with a mean age of 37 years. The average time from surgery to questionnaire completion was 62 days. Fractures treated include: frontal sinus=7, isolated orbit=23, zygomaticomaxillary complex=20, isolated nasal bone=15, naso-orbitoethmoid=7, LeFort=20 and mandible=55. The mean satisfaction of the study population for each questionnaire is as follows: Satisfaction with Outcome = 68 ± 23, Psychological Well-Being = 79 ± 24, Social Function = 72 ± 25, and Satisfaction with Medical-Team = 94 ± 13. Twenty-seven patients were classified as having disfiguring injuries. These patients were more satisfied with the medical team (99 ± 3 vs 93 ± 14, p=0.023) however did not differ in satisfaction with respect to outcome (68±28 vs 68 ± 21, p=0.947), psychological-well-being (79±26 vs 79 ± 23, p=0.919), and social function (72±25 vs 72 ± 25, p=0.991). CONCLUSIONS: This is the first study using the FACE-Q questionnaire to evaluate trauma patient satisfaction after facial reconstruction. Disfiguring injuries did not correlate with worse patient-reported outcomes which may be indicative of the positive impact that surgical reconstruction had on these patients. The FACE-Q questionnaires can be a valuable tool in assessing patient-reported outcomes in facial reconstruction. Reference Citations: 1. Klassen AF, Cano SJ, Pusic AL. FACE-Q Satisfaction with Appearance Scores from Close to 1000 Facial Aesthetic Patients. Plast Reconstr Surg. 2016;137(3):651e-652e. 2. Sinno S. Anzai L., Thorne CH. SJ. Face-Lift Satisfaction Using the FACE-Q. Plast Reconstr Surg. 2015;136(2):239–242. 3. Schwitzer JA, Sher SR, Fan KL, Scott AM, Gamble L, Baker SB. Assessing Patient-Reported Satisfaction with Appearance and Quality of Life following Rhinoplasty Using the FACE-Q Appraisal Scales. Plast Reconstr Surg. 2015;135(5):830e-837e.

UK-based prospective cohort study to anglicise and validate the FACE-Q Skin Cancer Module in patients with facial skin cancer undergoing surgical reconstruction: the PROMISCR (Patient-Reported Outcome Measure in Skin Cancer Reconstruction) study

IntroductionSkin cancer is the most common malignancy worldwide, often occurring on the face, where the cosmetic outcome of treatment is paramount. A number of skin cancer-specific patient-reported outcome measures (PROMs)...

Minimal Undermining Suspension Technique (MUST): Combined Eyebrow and Mid-face Lift via Temporal Access.

Less downtime following esthetic interventions leads to the popularity of injectable solutions for facial rejuvenation treatments. Surgical interventions for esthetic purposes are usually associated with higher complication rates and longer recovery times when compared to less invasive treatments. Here we present for the first time a minimally invasive surgical technique for a simultaneous mid-face and eyebrow lift using one small temporal incision. We prospectively studied patients who underwent facial rejuvenation using a minimal undermining suspension technique (MUST) in an outpatient setting. Postoperatively, surgical complications were classified according to the Clavien-Dindo classification. Preoperatively and at 12-month post-intervention, patient-reported outcomes were described using the FACE-Q questionnaire. Pre- and postoperative pictures were compared using MERZ Aesthetic Scales. Fifty-five patients (50 females and 5 males) with a mean age of 47years were studied. The overall complication rate was 19%, whereas 18 patients (15%) developed an ecchymosis of the orbicular temporal region and two patients (4%) developed a dimple caused by the anchor of the suture. No displacements of the palpebral rim or injuries to the facial nerve were observed. Recovery time was in average 7days and no long-term complications were seen. Both, the FACE-Q and the MERZ Aesthetic Scales showed significant improvements at 12-month post-surgery (p<0.01). The MUST can be used as a minimal invasive procedure for facial rejuvenation with a short downtime and low complication rate. The discreet temporal access and the MUST dissector allowed a safe dissection of anatomical tissue planes to perform safely a mid-face and eyebrow lift. Further studies are warranted to prove long-term outcomes. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the A3 online Instructions to Authors. www.springer.com/00266 .