Influence of aesthetic procedures on satisfaction and quality of life in older adult dental patientsAbstract
Aim Older adults are an increasingly significant group of consumers of cosmetic procedures, particularly minimally invasive aesthetic treatments. However, scientific data of these procedures in older populations remain limited. This study evaluated the self-perception of facial aesthetics and quality of life among older adults who have undergone minimally invasive facial rejuvenation procedures.
Methods Older adults who seek aesthetic treatment at a Dental School were recruited. They underwent treatments such as botulinum toxin injections, dermal fillers, microneedling, collagen biostimulators, chemical peels, and facial threads (experimental group, n = 61). Older adults who had not undergone any aesthetic procedures were also recruited (controls, n = 61) Satisfaction with facial appearance and health-related quality of life were assessed using the Brazilian version of the Satisfaction with Facial Appearance Overall Scale (FACE-Q) and the Portuguese version of World Health Organization Quality of Life for Older Persons (WHOQOL-OLD) questionnaire, respectively. Data were analyzed using exploratory methods and independent t-tests (α = 0.05).
Results Older adults who had undergone aesthetic procedures reported significantly lower satisfaction with their facial appearance (P < .001). However, they demonstrated a significantly higher overall quality of life (P = .024).
Conclusion Although minimally invasive aesthetic procedures may enhance the overall quality of life in older adults treated in a Dental School, they do not necessarily increase satisfaction with facial appearance. Results should be interpreted with caution, as they may not be generalized to all older adults, particularly those who do not wear dentures.
Keywords:
Aged; Esthetics; Personal satisfaction; Quality of life
Introduction
The global demographic profile shows a significant increase in the number of older individuals, particularly in developed countries1. In developing nations such as Brazil, population aging is also a growing reality. It is estimated that in the very near future, the number of older adults in Brazil will be sixteen times higher than in the past, placing the country sixth worldwide in terms of elderly population1.
Population aging is closely linked to increased life expectancy. However, it has also become a challenge to prevailing aesthetic standards, as many natural aspects of aging are often perceived as medical or social issues, and many older adults seek intervention by health professionals2,3. A survey found that approximately 70% of individuals who undergo aesthetic treatments consider cosmetic procedures4 in order to boost confidence and appear younger or more attractive5. Thus, aging well has become the new target of preventive medicine, being adults greater than 65 years of age an important and growing group of consumers of cosmetic procedures6. However, scientific evaluation of esthetic procedures in older adults is still lacking.
Facial aesthetic procedures include both surgical and minimally invasive techniques. The latter do not involve major incisions, avoid surgery, and generally require minimal recovery time7. Minimally invasive facial procedures include botulinum toxin injections, dermal fillers (e.g., hyaluronic acid, calcium hydroxyapatite, autologous fat), microdermabrasion, microneedling, collagen biostimulators, chemical peels, facial threads, laser treatments, radiofrequency, and micro-focused ultrasound8. Among these, the use of botulinum toxin A, alone or combined with fillers, stands out as the most popular method for addressing facial aging9, significantly enhancing satisfaction with facial appearance10. Although botulinum toxin A is officially approved for use in adults under the age of 6511, there are reports6,12 of its use in older adults. However, data on satisfaction with such procedures among the elderly population remain limited.
Therefore, this study aimed to evaluate the self-perception of facial aesthetics among older adults who undergo minimally invasive facial aesthetic procedures compared to those who do not. Additionally, it sought to determine whether these procedures impact the quality of life of adults greater than 65 years of age. The working hypothesis of the study is that minimally invasive aesthetic procedures influence the quality of life of older adults. It is also hypothesized that elderly individuals who undergo these procedures have a different self-perception of facial aesthetics compared to those who do not.
Materials and Methods
Study Design and sample
This cross-sectional study included two groups of older adults: those who had undergone minimally invasive facial aesthetic procedures (experimental group, n = 61) and those who had not undergone any facial aesthetic procedures (controls, n = 61). All volunteers were aged over 65 years, completely dentate, partial or completely edentulous (using or not any kind of dental prostheses), and free of parafunctional habits. Older adults presenting age-related diseases, such as hypertension and/or diabetes, once controlled by medication were also accepted. Subjects were excluded if they had severe periodontal diseases, physical or cognitive limitations, temporomandibular disorders, or had undergone any type of surgical aesthetic intervention.
The sample size was determined based on a pilot study that assessed facial aesthetic satisfaction in 20 volunteers (10 from each group). Data were analyzed using G*Power 3.1 software (Düsseldorf, Germany) to calculate the required sample size for a comparison of two independent means (two-tailed), with a significance level (α) of 5% and statistical power of 80%13. Based on these calculations, a total of 106 participants was required. To account for potential attrition, 61 elderly individuals were included in each group.
Participants in the experimental group were recruited from those who seek aesthetic procedures in the Orofacial Harmonization Extension Program at the São Leopoldo Mandic Dental School (Campinas, São Paulo, Brazil). Subjects were also recruited from older adults seeking treatment at Piracicaba Dental School, University of Campinas. To be eligible for the experimental group, participants must have undergone at least one minimally invasive facial aesthetic procedure. The control group consisted of older adults who had not undergone any facial aesthetic procedures.
The research protocol was approved by the Ethics Committee of the Piracicaba Dental School (protocol number: 77770824.1.0000.5374). Participation was voluntary, and all older adults provided written informed consent prior to enrollment.
After selection, all participants completed the Brazilian Portuguese version of the Satisfaction with Facial Appearance Overall Scale (FACE-Q)14 and the World Health Organization Quality of Life Questionnaire for Older Adults (WHOQOL-OLD)15, which assessed facial satisfaction and overall quality of life, respectively. Sociodemographic data were also collected.
Satisfaction with Facial Appearance Overall Scale
The culturally adapted and validated Brazilian Portuguese version of the FACE-Q was used14. This instrument includes 10 items that assess current perceptions of facial appearance in relation to symmetry, harmony, proportion, freshness or vitality, how the face looks over time (e.g., appearing rested), at the end of the day, upon waking, under bright lighting, and from self and side-profile views14.
Each item is rated on a 4-point Likert-type scale (very dissatisfied, somewhat dissatisfied, somewhat satisfied, very satisfied), producing a total score ranging from 10 to 40. This score is then converted into a standardized score ranging from 0 to 100, with higher scores indicating greater satisfaction with facial appearance14.
Health-Related Quality of Life
Health-Related Quality of Life was assessed using the Portuguese version of the World Health Organization Quality of Life for Older Persons (WHOQOL-OLD) module15. This instrument consists of 24 questions that assess the individual’s perception of aspects of their life in the last two weeks. It takes into account the impact of overall health on quality of life in the following domains: sensory abilities, autonomy, past, present and future activities, social participation, death and dying, and intimacy. Each item is rated on a 5-point Likert scale (Not at all, Very little, More or less, Quite a lot, Extremely), and scores from the six domains are combined to generate an overall quality of life score16. The total score on the questionnaire ranges from zero to 100 points, with a higher score representing a better health-related quality of life15.
Statistical Analysis
Statistical analyses were performed using SPSS Statistics software (Version 25.0; IBM Corporation, Chicago, IL, USA), with a significance level set at 5%. Data normality was assessed using the Kolmogorov-Smirnov test. For normally distributed variables, independent t-tests were conducted to compare the groups.
Results
The final study cohort (n = 122; 95 women, 27 men) consisted of 61 older adults who had undergone minimally invasive facial aesthetic procedures and 61 who had not. The sociodemographic characteristics of the study population are presented in Table 1. Participants were between 65 and 86 years of age, with a mean age of 69.51 ± 6.07 years. Most volunteers who underwent facial aesthetic procedures were female, non-smokers, married, and with a low educational level. In addition, regardless of the group they belong to, the majority of volunteers were removable denture wearers.
Table 1 also shows the most performed aesthetic procedure was botulinum toxin injection. Regarding primary aesthetic concerns, 92% of participants reported wrinkles in the periorbital area, 81% in the perioral region, 75% reported loss of facial support, 60% noted dry skin, and 26% cited periorbital pigmentation as a concern. The most performed aesthetic procedure was botulinum toxin injection.
Comparisons between groups revealed significant differences in facial aesthetic satisfaction, with the control group reporting higher satisfaction levels (P < .001) (Table 2). Conversely, participants who had undergone minimally invasive aesthetic procedures demonstrated significantly better overall quality of life (P = .024), particularly in the domains of sensory abilities (P = .020), autonomy (P = .005), and intimacy (P = .008) (Table 2).
Discussion
This study investigated whether elderly individuals who undergo minimally invasive facial aesthetic procedures are more satisfied with their facial appearance and have a better quality of life than those who do not. Results showed that, although participants who underwent such procedures reported better quality of life, supporting the study’s working hypothesis, they still had a poor self-perception of their facial aesthetics.
The sociodemographic characteristics of the elderly participants were similar to those reported in studies involving adult populations17-19, with the majority being married females. This may reflect societal pressure on women to conform to beauty standards19, and the perception that physical attractiveness increases a woman’s chances of forming relationships with high-status partners20. Furthermore, most participants in the experimental group were retired and had low educational levels, a finding that contrasts with that of Sobanko et al.18 (2015), who found that highly educated, working adults were more likely to opt for minimally invasive procedures. It is possible that elderly individuals prefer such treatments due to their shorter recovery time6, lower incidence of side effects, and relatively lower costs compared to surgical alternatives18.
As shown in Table 1, although the majority of participants who sought or not facial aesthetic procedures were removable partial denture (RPD) wearers, and nearly 10% did not use any prosthetic devices. Since RPDs are essential for rehabilitating missing teeth and supporting soft tissue volume21, it is important to emphasize to older adults that oral rehabilitation plays a crucial role in restoring both masticatory function and facial aesthetics. Therefore, prosthetic treatment should ideally precede facial aesthetic procedures.
The most common complaints among participants in the experimental group were wrinkles, followed by concerns related to the perioral region and loss of facial support. These findings are consistent with the Plastic Surgery Statistics Report4 (2020), which indicated that wrinkles and facial volume loss are among the most frequently cited concerns in aesthetic consultations. Similarly, botulinum toxin injections and dermal fillers were the most commonly performed procedures among participants, aligning with previous reports on facial rejuvenation trends8,22.
It is well-documented that individuals who undergo minimally invasive procedures often evaluate their facial appearance more critically23,24, and this trend appears to persist in older populations. In this study, even after receiving aesthetic treatments, participants in the experimental group reported lower satisfaction with their facial appearance compared to those in the control group. Although such procedures can produce rapid and noticeable improvements25, their effects may be less pronounced in elderly individuals due to age-related loss of skin elasticity and structural support22. As a result, the aesthetic outcomes may fall short of expectations, particularly regarding wrinkle reduction and lower-face volume restoration. This partial dissatisfaction may lead to continued pursuit of additional aesthetic treatments in an effort to meet perceived beauty standards18.
In terms of quality of life, elderly individuals who underwent aesthetic procedures reported higher scores overall. This finding supports previous studies, such as that of Aquino et al.23 (2012), which found that minimally invasive treatments improved the quality of life in adult women by enhancing self-esteem and emotional well-being, and fostering improvements in intimate relationships and autonomy23,24. It is plausible that elderly women experience similar benefits, particularly those who are married, as was the case for the majority of participants in the present study.
It is important to note that the WHOQOL-OLD domains don’t really look directly at facial aesthetics. However, it was developed as a specific instrument to measure quality of life in older adults, and it is a useful alternative with good psychometric performance in the investigation of quality of life in older adults15.
This study has some limitations. Although many participants were denture wearers, the status and quality of their prostheses were not evaluated. Considering that prosthesis condition, especially in the perioral region, can influence facial aesthetic self-perception26, this may have impacted the results. Future studies should investigate the relationship between removable prosthesis use and self-perceived facial aesthetics in older adults undergoing facial aesthetic procedures. Such research could help determine whether a multidisciplinary approach combining oral rehabilitation with aesthetic treatments can improve satisfaction with facial appearance in older adults. In addition, as our volunteers were recruited from a Dental School population, and the most of them were dentures users, our findings should not be generalized to all older adults, mainly to those who do not use dentures or any oral prosthetic device. Despite that, our findings impact practice since caution should be exercised when recommending minimally invasive aesthetic procedures to older adults.
Based on the findings of this study, it can be concluded that older adults who undergo minimally invasive orofacial harmonization procedures in a Dental Schools tend to have a poorer self-perception of their facial aesthetics, despite experiencing a better quality of life, particularly in areas related to sensory abilities, autonomy, and intimacy.
References
- 1 Carvalho JA, Rodríguez-Wong LL. [The changing age distribution of the Brazilian population in the first half of the 21st century]. Cad Saude Publica. 2008 Mar;24(3):597-605. Portuguese. doi: 10.1590/s0102-311x2008000300013.
-
2 Alves MC, Abla LE, Santos RA, Ferreira LM. Quality of life and self-esteem outcomes following rhytidoplasty. Ann Plast Surg. 2005 May;54(5):511-4; discussion 515-6. doi: 10.1097/01.sap.0000155274.59248.57.
» https://doi.org/10.1097/01.sap.0000155274.59248.57 -
3 Brito MJA, Nahas FX, Cordás TA, Tavares H, Ferreira LM. Body dysmorphic disorder in patients seeking abdominoplasty, rhinoplasty, and rhytidectomy. Plast Reconstr Surg. 2016 Feb;137(2):462-71. doi: 10.1097/01.prs.0000475753.33215.8f.
» https://doi.org/10.1097/01.prs.0000475753.33215.8f -
4 American Society of Dermatologic Surgery. New survey results showcase dermatologists as the primary influencer for patients' cosmetic procedures and skin care decisions. [2023?] Available from: https://www.asds.net/skin-experts/news-room/press-releases/new-survey-results-showcase-dermatologists-as-the-primary-influencer-for-patients-cosmetic-procedures-and-skin-care-decisions
» https://www.asds.net/skin-experts/news-room/press-releases/new-survey-results-showcase-dermatologists-as-the-primary-influencer-for-patients-cosmetic-procedures-and-skin-care-decisions -
5 Cavalcanti AN, Azevedo JF, Mathias P. [Orofacial harmonization: dentistry beyond the smile]. J Dent Public Health. 2017;8(2):35-6. Portuguese. doi: 10.17267/2596-3368dentistry.v8i2.1454.
» https://doi.org/10.17267/2596-3368dentistry.v8i2.1454 -
6 Mobayed N, Nguyen JK, Jagdeo J. Minimally invasive facial cosmetic procedures for the millennial aesthetic patient. J Drugs Dermatol. 2020 Jan;19(1):100-3. doi: 10.36849/JDD.2020.4641.
» https://doi.org/10.36849/JDD.2020.4641 -
7 American Society of Plastic Surgeons. Plastic Surgery Statistics. Plastic surgery procedural statistics from the American Society of Plastic Surgeons. 2020. Arlington Heights (IL). Available from: https://www.plasticsurgery.org/news/plastic-surgery-statistics?sub=2020+Plastic+Surgery+Statistics
» https://www.plasticsurgery.org/news/plastic-surgery-statistics?sub=2020+Plastic+Surgery+Statistics -
8 Spiegel JH. Treatment of periorbital rhytids with botulinum toxin type A: maximizing safety and results. Arch Facial Plast Surg. 2005 May-Jun;7(3):198-202. doi: 10.1001/archfaci.7.3.198.
» https://doi.org/10.1001/archfaci.7.3.198 - 9 Hibler BP, Schwitzer J, Rossi AM. Assessing improvement of facial appearance and quality of life after minimally-invasive cosmetic dermatology procedures using the FACE-Q scales. J Drugs Dermatol. 2016 Jan;15(1):62-7.
-
10 Cheng CM. Cosmetic use of botulinum toxin type A in the elderly. Clin Interv Aging. 2007;2(1):81-3. doi: 10.2147/ciia.2007.2.1.81.
» https://doi.org/10.2147/ciia.2007.2.1.81 -
11 Wollina U, Payne CR. Aging well--the role of minimally invasive aesthetic dermatological procedures in women over 65. J Cosmet Dermatol. 2010 Mar;9(1):50-8. doi: 10.1111/j.1473-2165.2010.00475.x.
» https://doi.org/10.1111/j.1473-2165.2010.00475.x -
12 Piaia TC, Souza DM, Souza MS, Tortelli SAC. [Protocol for minimally invasive facial rejuvenation in elderly]. Aesth Orofacial Sci 2021;2(1):15-26. Portuguese. doi: 10.51670/aos.v2i1.40.
» https://doi.org/10.51670/aos.v2i1.40 - 13 Faul F, Erdfelder E, Buchner A, Lang AG. Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. Behav Res Methods. 2009 Nov;41(4):1149-60. doi: 10.3758/BRM.41.4.1149.
-
14 Gama JT, Rossetto LA, Brito NB, Veiga DF, Ferreira LM. Cross-cultural validation of the FACE-Q Satisfaction with Facial Appearance Overall Scale (FACE-Q SFAOS) in Brazilian rhytidoplasty patients. Clinics (Sao Paulo). 2020;75:e1568. doi: 10.6061/clinics/2020/e1568.
» https://doi.org/10.6061/clinics/2020/e1568 -
15 Fleck MP, Chachamovich E, Trentini C. Development and validation of the Portuguese version of the WHOQOL-OLD module. Rev Saude Publica. 2006 Oct;40(5):785-91. doi: 10.1590/s0034-89102006000600007.
» https://doi.org/10.1590/s0034-89102006000600007 -
16 Zimpel RR, Panzini RG, Bandeira DR, Fleck MP, da Rocha NS. Psychometric properties of the WHOQOL-SRPB BREF, Brazilian Portuguese version. Braz J Psychiatry. 2019 Apr;41(5):411-8. doi: 10.1590/1516-4446-2018-0083.
» https://doi.org/10.1590/1516-4446-2018-0083 -
17 Cosmetic Surgery National Data Bank: Statistics 2013. Aesthet Surg J. 2014 Jun;34(1 suppl):1S-22S. doi: 10.1177/1090820X14542571.
» https://doi.org/10.1177/1090820X14542571 -
18 Sobanko JF, Taglienti AJ, Wilson AJ, Sarwer DB, Margolis DJ, Dai J, et al. Motivations for seeking minimally invasive cosmetic procedures in an academic outpatient setting. Aesthet Surg J. 2015 Nov;35(8):1014-20. doi: 10.1093/asj/sjv094.
» https://doi.org/10.1093/asj/sjv094 -
19 Frederick DA, Lever J, Peplau LA. Interest in cosmetic surgery and body image: views of men and women across the lifespan. Plast Reconstr Surg. 2007 Oct;120(5):1407-15. doi: 10.1097/01.prs.0000279375.26157.64.
» https://doi.org/10.1097/01.prs.0000279375.26157.64 -
20 Tucker A. How much is being attractive worth? Smithsonian Magazine. 2012 Nov [cited 2024 Jul 14]. Available from: http://www.smithsonianmag.com/science-nature/howmuch-is-being-attractive-worth-80414787/?no-ist
» http://www.smithsonianmag.com/science-nature/howmuch-is-being-attractive-worth-80414787/?no-ist -
21 Bohnenkamp DM. Removable partial dentures: clinical concepts. Dent Clin North Am. 2014 Jan;58(1):69-89. doi: 10.1016/j.cden.2013.09.003.
» https://doi.org/10.1016/j.cden.2013.09.003 -
22 Zins JE, Moreira-Gonzalez A. Cosmetic procedures for the aging face. Clin Geriatr Med. 2006 Aug;22(3):709-28. doi: 10.1016/j.cger.2006.05.003.
» https://doi.org/10.1016/j.cger.2006.05.003 -
23 Aquino MS, Haddad A, Ferreira LM. Assessment of quality of life in patients who underwent minimally invasive cosmetic procedures. Aesthetic Plast Surg. 2013 Jun;37(3):497-503. doi: 10.1007/s00266-012-9992-0.
» https://doi.org/10.1007/s00266-012-9992-0 -
24 Dayan SH, Arkins JP, Patel AB, Gal TJ. A double-blind, randomized, placebo-controlled health-outcomes survey of the effect of botulinum toxin type a injections on quality of life and self-esteem. Dermatol Surg. 2010 Dec;36 Suppl 4:2088-97. doi: 10.1111/j.1524-4725.2010.01795.x.
» https://doi.org/10.1111/j.1524-4725.2010.01795.x - 25 Maia IEF, Salvi JO. [The use of hyaluronic acid in facial harmonization: a brief review]. Bras J Surg Clin Res 2018;23(2):135-9. Portuguese.
- 26 Iordanova MV, Iordanova SV, Chaprashikian OG. Changes of the facial soft tissue profile in complete denture prosthetic treatment. Folia Med (Plovdiv). 2006;48(3-4):74-8.
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Data availability:
Datasets related to this article will be available to the corresponding author upon request.
Edited by
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Editor:
Dr. Altair A. Del Bel Cury
Datasets related to this article will be available to the corresponding author upon request.
