Combined trichloroacetic acid peel and topical ascorbic acid versus trichloroacetic acid peel alone in the treatment of melasma: a comparative study

Low-level laser therapy for skin rejuvenation: A safe and effective solution baked by data and visual evidence

BACKGROUND

Skin aging and photoaging is a process that may appear at a relatively early age, causing an aesthetic problem. Common signs of skin aging include wrinkles, dyspigmentation, and decreased elasticity.

AIM

Aim of this article is to study the effectiveness and safety of low-level laser therapy (LLLT) for skin rejuvenation.

METHODS

Thirty Syrian female patients aged 25-50 participated in this study and were diagnosed with moderate to severe melasma and wrinkles. The patients were divided into two groups and received LLLT with a wavelength of 660 nm emitting a continuous wave. The power density and dose used were 15.6 mW/cm2, and 3 J/cm2 respectively, and the laser effective area was 32 cm2. The evaluation was done before, during, and after 12 treatment sessions, based on photographs, in addition to the modified Melasma Area Severity Index (MASI), Pinch test, and Fitzpatrick's classification of facial wrinkling at baseline.

RESULTS

Comparing before, and after treatment, and between the two groups, revealed a significant improvement in skin rejuvenation, with a statistical significance (p < 0.05). Additional outcome measures included assessments of patient satisfaction scores, and no adverse effects or re-pigmentation were reported.

CONCLUSIONS

Our results suggest that LLLT may be a useful and safe therapeutic option in treating melasma, skin elasticity, and wrinkle improvement, which we advised to be integrated into treatment, and follow-up programs in cosmetics and dermatology.

Melasma: A Step-by-Step Approach Towards a Multimodal Combination Therapy

Melasma is a common challenge in the field of pigmentary skin disorders, exerting a significant emotional and psychosocial burden on patients. The persistent and recurring nature of melasma complicates its management in routine clinical practice. This comprehensive review outlines a stepwise, practical approach encompassing diagnostic, preventive and therapeutic strategies for the management of melasma. A thorough exploration of aggravating and exacerbating factors, including sun exposure, hormonal imbalances, photosensitizing medication and cosmetics, is essential for a holistic assessment of the disease. With an emphasis on consistent and effective photoprotection, initial topical treatment modalities target the melanin production and/or the transfer of melanosomes to keratinocytes. Topical tyrosine inhibitors emerge as the first choice for reducing and preventing hyperpigmentation, with compounds such as thiamidol or tranexamic acid (TXA) being preferred for their safety profile over hydroquinone (HQ), kojic acid and arbutin. Combination with chemical peels can further enhance the therapeutic efficacy, even in cases with resistant melasma. In more severe cases, laser- and light-based interventions may be considered, but with the caveat of the likelihood of recurrence within 3-6 months. Assisted TXA delivery, via either fractional non-ablative laser or microneedling techniques, can further improve clinical outcomes. In conclusion, an optimal melasma management strategy is a multimodal approach, which includes effective photoprotection and a mix of different topical treatments targeting melanin synthesis, the anti-inflammatory environment, senescence and vascularity. Complementary procedures, such as chemical peels, and laser, light-based or microneedling procedures, with or without TXA, can further expedite melanin clearance in more severely affected instances. Individual discussions with patients regarding treatment expectations, recurrence likelihood and potential side effects are paramount to a comprehensive and successful therapeutic journey.

Chemical Peels for Melasma: A Systematic Review

BACKGROUND

Melasma is a common chronic, relapsing pigmentary disorder that causes psychological impact. Chemical peels are a well-known therapeutic modality used for accelerating the treatment of melasma.

OBJECTIVE

To review the published evidence on the efficacy and safety of chemical peels in the treatment of melasma.

METHODS

A systematic review was done. A meta-analysis could not be done due to the heterogeneity of data.

RESULT

The authors conducted a PubMed search and included prospective case series of more than 10 cases and randomized controlled trials (RCTs) that have studied the safety and/or efficacy of chemical peel in melasma. Out of 24 studies, 9 were clinical/comparative trials and 15 were RCTs. The total sample size was 1,075. The duration of the study varied from 8 to 36 weeks. Only 8 studies were split face. All studies used self-assessment, physician global assessment, and Melasma Area and Severity Index (MASI) for quantifying the results. Glycolic acid was found to be the most safe and effective in melasma.

CONCLUSION

Chemical peels were found to be safe and effective in the management of melasma.

Chemical Peels in Treatment of Melasma

Superficial chemical peels are one of the most popular skin resurfacing procedures in a dermatologists' clinic today due to quick application process, fast recovery, good patient acceptance, and excellent cosmetic results. The role of various peeling agents like glycolic acid, salicylic acid, trichloroacetic acid, Jessner's solution, retinoic acid, and lactic acid in the management of melasma has been established as that of an additional or maintenance therapy. This article details the current evidence and recommendations for the use of chemical peels in the treatment of melasma, a chronic and recurrent hyperpigmentary disorder.

The Impact of Antioxidants on Vitiligo and Melasma: A Scoping Review and Meta-Analysis

Reactive oxygen species (ROS) generated during melanogenesis make melanocytes particularly vulnerable to oxidative stress, influencing their survival and melanin synthesis. Oxidative stress, significantly present in vitiligo and recently also detected in melasma, triggers inflammatory cascades and melanogenesis, making antioxidants a promising therapeutic avenue. A systematic search was conducted on Embase and Pubmed to study the efficacy of antioxidants for treating vitiligo and/or melasma. Meta-analysis was performed to assess the difference in Melasma Severity Index (MASI) scores between baseline and follow-up. Various antioxidants like polypodium leucotomos, ginkgo biloba, catalase/superoxide dismutase, and vitamin E have potential in vitiligo. For melasma, vitamin C, silymarin, and niacinamide were among those showing promise in reducing pigmentation, with vitamin C displaying significant effects in meta-analysis. Different antioxidants improve both vitiligo and melasma, with an increased minimal erythema dose (MED) following UV exposure being significant for vitiligo and tyrosinase inhibition being crucial for melasma. However, the efficacy of individual antioxidants varies, and their exact mechanisms, especially in stimulating melanocyte proliferation and anti-inflammatory pathways, require further investigation to understand better and optimize their use.

TFOS Lifestyle: Impact of cosmetics on the ocular surface

In this report the use of eye cosmetic products and procedures and how this represents a lifestyle challenge that may exacerbate or promote the development of ocular surface and adnexal disease is discussed. Multiple aspects of eye cosmetics are addressed, including their history and market value, psychological and social impacts, possible problems associated with cosmetic ingredients, products, and procedures, and regulations for eye cosmetic use. In addition, a systematic review that critically appraises randomized controlled trial evidence concerning the ocular effects of eyelash growth products is included. The findings of this systematic review highlight the evidence gaps and indicate future directions for research to focus on ocular surface outcomes associated with eyelash growth products.

Disorders of hyperpigmentation. Part II. Review of management and treatment options for hyperpigmentation

Key challenges in the management of pigmentary disorders such as melasma and postinflammatory hyperpigmentation are their resistance to treatment, tendency to recur after treatment, and the risk of exacerbating hyperpigmentation with many treatment modalities. The second article in this 2-part continuing medical education series on pigmentary disorders focuses on the evidence behind medical and procedural treatments of dyschromias, including photoprotection, topical lightening agents, oral agents, chemical peels, and laser therapy.

Understanding Melasma-How Can Pharmacology and Cosmetology Procedures and Prevention Help to Achieve Optimal Treatment Results? A Narrative Review

Melasma is a chronic skin condition that involves the overproduction of melanin in areas exposed to ultraviolet radiation. Melasma treatment is long-term and complicated with recurrence and resistance to treatment. The pathogenesis of melasma is highly complex with multiple pathologies occurring outside of the skin pigment cells. It includes photoaging, excessive melanogenesis, an increased number of mast cells, increased vascularization, and basement membrane damage. In addition, skin lesions related to melasma and their surrounding skin have nearly 300 genes differentially expressed from healthy skin. Traditionally, melasma was treated with topical agents, including hydroquinone, tretinoin, glucocorticosteroids and various formulations; however, the current approach includes the topical application of a variety of substances, chemical peels, laser and light treatments, mesotherapy, microneedling and/or the use of systemic therapy. The treatment plan for patients with melasma begins with the elimination of risk factors, strict protection against ultraviolet radiation, and the topical use of lightening agents. Hyperpigmentation treatment alone can be ineffective unless combined with regenerative methods and photoprotection. In this review, we show that in-depth knowledge associated with proper communication and the establishment of a relationship with the patient help to achieve good adherence and compliance in this long-term, time-consuming and difficult procedure.

The Application of Skin Care Product in Melasma Treatment

Melasma is an acquired and chronic hyperpigmentation disorder which is recognized as one of the most psychologically distressing and difficult to cure forms of skin hyperpigmentation. It is associated with substantial quality of life impairments. Treatments of melasma include local application, oral medication, physical laser therapy and program combination therapy. However, routine treatment usually leads to the damage of skin barrier function, resulting in adverse reactions such as erythema, pruritus, post-inflammatory pigmentation and even scar. Skin care products contain a variety of active ingredients, which are widely concerned by cosmetic dermatologists because of high safety, good tolerance and the effect of improving the damaged skin barrier. Using skin care products alone or in combination with routine treatment not only can improve the curative effect for melasma, reduce side effects and recurrence rate, but also improve patient satisfaction. This article mainly describes the application of skin care products in the treatment of melasma.

Treatment of melasma: a review of less commonly used antioxidants

Melasma, a common cause for seeking dermatologic care, is a chronic condition of skin hyperpigmentation. With a poorly understood pathogenesis, and no universal cure, melasma is a challenge for many dermatologists. For decades, there has been investigation into the role of oxidative stress in melasma. In this literature review, we introduce the role of oxidative stress in melasma and discuss the function of various topical and oral antioxidant therapies for patients suffering from melasma. Numerous studies have shown efficacy of various antioxidant therapies for treatment of hyperpigmentation, and in this review, we focus primarily on those with less widespread use. Vitamin E, niacinamide, polypodium leucotomos, pycnogenol, grape seed extract, amino fruit acids, phytic acid, zinc, silymarin, Korean red ginseng powder, plant extracts, and parsley all have well-demonstrated evidence of antioxidant properties, and these substances have been studied in the context of skin hyperpigmentation. Although there is conflicting evidence of their therapeutic efficacy, the use of these naturally occurring substances is promising for patients and medical providers seeking alternative therapeutic options.

Ascorbic acid derivative-loaded modified aspasomes: formulation, in vitro, ex vivo and clinical evaluation for melasma treatment

Vitamin C (L-Ascorbic acid) has many favourable effects on the skin such as antioxidant, anti-aging and whitening effects. Its instability and low permeability limit its pharmaceutical use in cosmetic and dermatological products. Instead, Mg ascorbyl phosphate (MAP), an ascorbic acid derivative, has the same effect with higher stability is being used. In this work, a vesicular system, aspasomes, containing MAP was developed and evaluated. Aspasomes are multilayered vesicles formed by amphiphiles molecules, Ascorbyl palmitate (ASP), in combination with cholesterol and charged lipids for drug encapsulation. Here, we investigated the use of lecithin instead of the charged lipid dicetyl phosphate for aspasomes development. Nine formulations were prepared and evaluated for their entrapment efficiency, particle size, polydispersity index (PDI) and zeta potential. Their entrapment efficiency ranged from 33.00 ± 2.27 to 95.18 ± 1.06, while their particle size was from 373.34 ± 60.85 to 464.37 ± 93.46 nm with acceptable PDI (from 0.212 ± 0.068 to 0.351 ± 0.061) and zeta potential (from -37.52 ± 2.42 to -50.36 ± 1.82). Three formulations were selected and evaluated for their drug release, permeation and retention into skin. One formulation was selected to be formulated as aspasomal topical cream and gel. The aspasomal cream was found to have enhanced drug permeation and skin retention over the aspasomal gel as well as the aspasomes formulation. MAP aspasomal cream was evaluated clinically as an effective treatment for melasma against 15% trichloroacetic acid (TCA) and the results recorded that the aspasomal cream showed the greatest degree of improvement regarding the hemi-MASI scores with 35% of patients rating it as excellent treatment. The study showed that MAP aspasomal cream can be considered a novel treatment of melasma which is free of side effects. Its efficacy as a monotherapy is superior to that of chemical peeling using 15% TCA.

Chemical Peels in Melasma: A Review with Consensus Recommendations by Indian Pigmentary Expert Group

Melasma is a notorious dermatosis, often resistant to treatment. Chemical peeling constitutes an acceptable option of management of melasma (of any type and duration). In this article, as a group of experts from Pigmentary Disorders Society (PDS) in collaboration with South Asian Pigmentary Forum (SPF), we have tried to elaborate the various chemical peeling agents for the treatment of melasma. Besides, we have reviewed the indications, mechanism of action, rationality and the detailed procedure of peeling. The evidence in favor of various peeling agents have been summarized as well.

Clinical Efficacy and Safety on Combining 20% Trichloroacetic Acid Peel with Topical 5% Ascorbic Acid for Melasma

Introduction

Trichloroacetic Acid (TCA) is a versatile peeling agent for treatment of melasma. However, Post-Inflammatory Hyperpigmentation (PIH) is reported to be the most common side-effect associated with TCA peel. Topical Ascorbic Acid (AA) due to its effect as antioxidant and tyrosinase inhibitor helps to prevent PIH and maintains the response.

Aim

To assess the clinical efficacy, safety and reduction in Melasma Quality of Life (MELASQOL) on combining 20% TCA peel with 5% ascorbic acid cream in epidermal melasma.

Materials and Methods

This study was conducted in the Department of Dermatology, Pt. Bhagwat Dayal Sharma University of Health Sciences, Rohtak. This was an open labelled prospective randomized study in which 60 patients of epidermal melasma were enrolled for 12 weeks. Patients were divided into two groups: Combination group received 20% TCA peel every two weeks with once daily 5% ascorbic acid cream and Control group received only 20% TCA peel. Melasma Area Severity Index (MASI) was used for evaluating clinical improvement of melasma. Improvement in Quality Of Life (QoL) was assessed by MELASQOL scale in both groups. Adverse effects were evaluated at each visit. All statistical analysis was carried out with SPSS 20^th version. The difference in change in mean MASI scoring and MELASQOL scores between the two groups were analysed using Mann-Whitney test. The side effects between the two groups were compared using Chi-square test.

Results

The combination group demonstrated a statistically significant improvement in MASI, percentage decrease in MASI and quality of life as compared to control group after treatment. At the baseline there was no statistically significant difference in MASI between the two groups (i.e., MASI in combination group and control group were 23.55±4.61 and 23.613±4.088 respectively). However, it was statistically significant at the end of therapy (i.e., MASI in combination group was 9.50±5.31 and in control group was 15.10±4.44). When the results were analysed in terms of percentage decrease in MASI from baseline, there was statistically significant difference in combination group (i.e., 10.87±4.11) as compared to control group (i.e., 6.3±1.97) after 2^nd week of therapy. When the mean MELASQOL scores were compared between the two groups at the end of therapy (i.e., 12 weeks), it was found to be statistically significantly lower in combination group (16.60±8.03) as compared to control group (25.90±8.17). Minor adverse effects like post peel erythema, pruritus, burning and stinging sensation were observed in some of the patients, which didn't necessitate termination of the therapy.

Conclusion

Combination of 20% TCA peel with topical 5% ascorbic acid is a highly effective, safe and promising therapeutic option in treatment of melasma which significantly improves the QoL.

Evidence-based Review, Grade of Recommendation, and Suggested Treatment Recommendations for Melasma

Treatment of melasma is known to be less satisfactory, often incomplete, and relapse is frequent. Although many treatment options are available, they are either known to be unsafe on long-term use or their long-term safety profile is unknown. Patients often use various drugs, even topical steroid-based preparation without any medical supervision for long period of time, making the skin unsuitable for many of the drugs available. Thus, there has been gross disparity among the treating physician about what drugs and what regimen are best suitable for various categories of melasma patients and in different situations. With this background, numerous newer drugs, mostly combinations of some proprietary molecules or even unknown plant extracts, have flooded the market for the management of melasma. Information on efficacy or safety of these products are almost unknown. Studies on Asian people, especially Indian population, are far less commonly available. Therapeutic guideline for use on Indian patients with melasma is almost missing. Extrapolation of data from Caucasian people for use on Asian people may not be scientifically justifiable because Caucasian and Asian people are known to have inherent difference in their response as well as tolerance to the drugs used for melasma. With this background, we have extensively evaluated, following a strict, scientifically designed protocol, all the available studies on melasma management till May 2016 and prepared this document on level of evidence, grade of recommendation and suggested therapeutic guideline for melasma as per the method proposed by Oxford Centre of Evidence-Based Medicine. Various ethical, social, logical, regional, and economic issues in the context of Indian and similar populations were given due importance while preparing the suggested therapeutic recommendation.

Comparative Evaluation of Topical 10% Potassium Hydroxide and 30% Trichloroacetic Acid in the Treatment of Plane Warts

Background:

Warts are benign proliferations of skin and mucosa caused by the human papillomavirus (HPV). Plane warts are caused by HPV types 3, 10, 28, and 41, occurring mostly in children and young adults. Among the treatment modalities, topical application of trichloroacetic acid (TCA) is age old. Potassium hydroxide (KOH) has a keratolytic effect on virus-infected cells. It is less irritating, less painful, less scar forming, and can be safely used in children too. Hence, it could be a better topical agent in the treatment of plane warts.

Aims and Objectives:

To compare the safety and efficacy of topical 10% KOH with 30% TCA in the treatment of plane warts.

Materials and Methods:

Sixty consecutive patients with plane warts were randomly assigned into two arms of thirty patients each; arm A received topical 10% KOH and arm B received topical 30% TCA as a once weekly application until the complete clearance of warts or a maximum period of 12 weeks.

Results:

Statistically no significant difference (P = 0.07) was found between the objective therapeutic response to 10% KOH and 30% TCA at the end of study (12 weeks). However, subjective response to 10% KOH was better and statistically significant (P = 0.03). There was no recurrence of warts seen on follow-up for 3 months of complete responders in both the arms.

Conclusion:

10% KOH is found to be equally effective in the treatment of plane warts compared to 30% TCA with the advantage of faster onset of action and tendency of completely clearing warts with fewer side effects.

Evaluation of 70% glycolic peels versus 15% trichloroacetic peels for the treatment of photodamaged facial skin in aging women

BACKGROUND

Chronic solar irradiation results in both morphological and functional changes in affected skin. Superficial peels have been shown to improve all symptoms of photodamaged skin.

OBJECTIVE

This study was designed to compare the efficacy and tolerability of glycolic acid (GA, 70%) with trichloroacetic acid (TCA, 15%) for the treatment of photoaging.

MATERIALS AND METHODS

Twenty female patients affected by photodamage were treated with graded concentrations of 70% GA and 15% TCA peel. Each patient was submitted to 5 sessions of these peels, with an interval of 14 days between each session. Four clinical parameters of surface evaluation of the living skin (hydration, elasticity, melanin, and erythema) were measured. The records were made before each treatment and 3 months after the last application.

RESULTS

The statistical significance in each group of patients was observed with elasticity and hydration. Decrease in melanin content in the skin occurred significantly after the application of a series of treatments with GA. Increase in severity of erythema showed statistical significance after the treatment with TCA.

CONCLUSION

Superficial peels, such as 70% GA and 15% TCA, proved to be an effective treatment modality for photodamaged facial skin. Both acids contribute to improvement of the photodamaged skin's parameters. Glycolic acid increases skin's hydration faster.

Comparative study of 15% TCA peel versus 35% glycolic acid peel for the treatment of melasma

BACKGROUND

Chemical peels are the mainstay of a cosmetic practitioner's armamentarium because they can be used to treat some skin disorders and can provide aesthetic benefit.

OBJECTIVES

To compare 15% TCA peel and 35% glycolic acid peel for the treatment of melasma.

MATERIAL AND METHODS

We selected 30 participants of melasma aged between 20 and 50 years from the dermatology outpatient department and treated equal numbers with 15% TCA and 35% glycolic acid.

RESULTS

Subjective response as graded by the patient showed good or very good response in 70% participants in the glycolic acid group and 64% in the TCA group.

CONCLUSIONS

There was statistically insignificant difference in the efficacy between the two groups for the treatment of melasma.

Cosmeceuticals: practical applications

Cosmeceuticals are topically applied products that are more than merely cosmetic, yet are not true drugs that have undergone rigorous placebo controlled studies for safety and efficacy. There are many review articles that outline the theoretical biologic and clinical actions of these cosmeceuticals and their various ingredients. This article reviews how to incorporate various cosmeceuticals into the treatment regime of patients, depending on the diagnosis and therapies chosen. The practical application of when, why, and on whom to use different products will enable dermatologists to improve the methodology of product selection and, ultimately, improve patient's clinical results.

A prospective, randomized, split-face, controlled trial of salicylic acid peels in the treatment of melasma in Latin American women

BACKGROUND

Melasma, a common disorder of hyperpigmentation, is often resistant to therapy. Although salicylic acid peels have been reported to be useful for patients with recalcitrant melasma, controlled trials are lacking.

OBJECTIVE

We sought to determine the efficacy of salicylic acid peels when added to hydroquinone in the treatment of melasma.

METHODS

Twenty Latin American women with moderate to severe bilateral melasma were treated with a series of 20% to 30% salicylic acid peels every 2 weeks for a total of 4 peels on one side of the face along with 4% hydroquinone cream to both sides of the face twice daily. The primary efficacy variable was reduction in pigmentation of the peeled side compared with the unpeeled side using narrowband reflectance spectrophotometry.

RESULTS

Eighteen patients completed the study. Although both sides had significant reduction in pigment intensity, there was no difference between the peeled and unpeeled side with all outcome measures.

LIMITATIONS

Patients were limited to Latin American women and only 4 peels were performed.

CONCLUSION

A series of four 20% to 30% salicylic acid peels are not effective in the treatment of melasma when added to twice-daily 4% hydroquinone cream.

A study comparing chemical peeling using modified Jessner's solution and 15% trichloroacetic Acid versus 15% trichloroacetic acid in the treatment of melasma

Background:

Melasma is a symmetric progressive hyperpigmentation of the facial skin that occurs in all races but has a predilection for darker skin phenotypes. Depigmenting agents, laser and chemical peeling as classic Jessner's solution, modified Jessner's solution and trichloroacetic acid have been used alone and in combination in the treatment of melasma.

Objectives:

The aim of the study was to compare the therapeutic effect of combined 15% Trichloroacetic acid (TCA) and modified Jessner's solution with 15% TCA on melasma.

Materials and Methods:

Twenty married females with melasma (epidermal type), with a mean age of 38.25 years, were included in this study. All were of skin type III or IV. Fifteen percent TCA was applied to the whole face, with the exception of the left malar area to which combined TCA 15% and modified Jessner's solution was applied.

Results:

Our results revealed statistically highly significant difference between MASI Score (Melasma Area and Severity Index) between the right malar area and the left malar area.

Conclusion:

Modified Jessner's solution proved to be useful as an adjuvant treatment with TCA in the treatment of melasma, improving the results and minimizing postinflammatory hyperpigmentation.

The prevalence of melasma and its association with quality of life in adult male Latino migrant workers

BACKGROUND

Melasma is a common condition of Latino women that detracts from their quality of life (QOL). The prevalence and impact of melasma in Latino men is not well characterized.

AIM

To assess the prevalence of melasma and its association with QOL in Latino men from Mexico and Central America working in the USA.

METHODS

The prevalence of melasma was assessed in three studies of Latino men: by direct examination in a study of 25 Latino poultry workers; by direct examination in a study of 54 Latino farm workers; and by examination of store-and-forward teledermatology images in a study of 300 Latino farm workers. QOL was assessed with a Spanish version of the Dermatology Life Quality Index (DLQI).

RESULTS

The prevalence of melasma was 36.0%, 7.4%, and 14.0% in the three studies. The prevalence of melasma was greatest amongst those aged 31 years and older, who were from Guatemala, and who spoke an indigenous language. The presence of melasma was associated with higher DLQI scores, indicating a poorer QOL, in the poultry worker population.

CONCLUSIONS

Melasma is a common condition in Latino men and is associated with a poor QOL in some affected individuals. Clinicians should be aware that melasma may be a concern for their male Latino patients. Research on the association of skin conditions with QOL amongst minority men is needed.

Outcome measures in facial plastic surgery: patient-reported and clinical efficacy measures

OBJECTIVE

To survey the existing literature to identify, summarize, and evaluate procedure- and condition-specific outcome measures for use in facial plastic and reconstructive surgery.

METHODS

A review of the English-language literature was performed to identify outcomes instruments specific for targeted facial plastic surgery interventions and conditions. A search was performed using MEDLINE (1950 to September 2007), CINAHL (Cumulative Index to Nursing & Allied Health) (1982 to September 2007), and PsychINFO (1806 to September 2007). Outcomes instruments were categorized as patient-reported or clinical efficacy measures (observer-reported or objective measures). Instruments were then categorized to include relevant details on the intervention, degree of validation, and subsequent use.

RESULTS

Sixty-eight distinct instruments were identified (23 patient-reported, 35 observer-reported, and 10 objective measures), with some overlap among categories. Most patient-reported measures (76%) and half observer-reported instruments (51%) were developed in the past 10 years. The rigor of validation varied widely among measures, with formal validation being most common among the patient-reported outcome measures.

CONCLUSIONS

Validated outcomes measures are present for many common facial plastic surgery conditions and have become more prevalent during the past decade, especially for patient-reported outcomes. Challenges remain in harmonizing patient-reported, observer-based, and other objective measures to produce standardized clinically meaningful outcome measures.