Beyond Satisfaction in Rhytidectomy: A COSMIN Systematic Review of Patient-Reported Outcome Measures and Reporting Quality

Introduction: Patient satisfaction is central to aesthetic rhytidectomy, but global satisfaction alone does not capture the full patient experience. Patient-reported outcome measures (PROMs) can assess appearance, psychosocial and social function, perceived aging, satisfaction, naturalness, and adverse effects, yet the measurement quality and reporting consistency of PROMs in rhytidectomy research remain unclear. Materials and Methods: Following COSMIN methodology and PRISMA-COSMIN guidance, PROM measurement property studies and clinical rhytidectomy studies were measured. Content validity, risk of bias, and good measurement property criteria were assessed; certainty was rated using modified Grading of Recommendations Assessment, Development and Evaluation; and instruments received COSMIN Category A, B, or C recommendations. Clinical studies were scored with a prespecified reporting-quality checklist adapted from FACE-Q best-practice criteria. Results: Thirteen measurement property studies and 12 clinical FACE-Q studies were included, with 3 additional studies using legacy instruments. FACE-Q Aesthetics had the most comprehensive measurement -property evidence, and its lower face and neck scales achieved COSMIN Category A. Clinical PROM use was heterogeneous, with recurrent postoperative-only assessment, variable timing, modified items, modest response rates, and inconsistent scoring. Discussion: In validated PROMs, inconsistent implementation limits comparison across techniques and studies. Older instruments retain historical value but offer limited contemporary validation, and FACE-Q domains validated in mixed facial aesthetic populations warrant indirectness-aware interpretation when applied to facelift outcomes. Conclusion: FACE-Q Aesthetics provides the strongest framework, with its lower face and neck scales the best-supported, rhytidectomy-specific set. Future studies should use complete validated scales, report transformed scores, and standardize PROM reporting.