Analysis of a Brazilian cross-cultural adaptation of the FACE-Q SFAOS in facial harmonization in dentistry

Albuquerque, Maria Carolina Portela; Guerra, Janaina Motta; Aguiar, Maria Thaynara; Caetano, Caio Ferreira Freire; Borges, Marcela Maria Fontes; Cetira Filho, Edson Luiz; Silva, Paulo Goberlânio de Barros; Sousa, Fabrício Bitu

doi:10.1590/1807-3107bor-2022.vol36.0050

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Original Research, Social/Community Dentistry • Braz. oral. res. 36 • 2022 • https://doi.org/10.1590/1807-3107bor-2022.vol36.0050 linkcopy

Analysis of a Brazilian cross-cultural adaptation of the FACE-Q SFAOS in facial harmonization in dentistry

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract:

The FACE-Q SFAOS is an instrument developed for esthetic facial procedures and has been validated in patients undergoing rhinoplasty. It consists of ten items that assess the current perception of facial appearance regarding symmetry, harmony, proportion, freshness or vitality, and self-perception of appearance; these items are perhaps important to guide demands in orofacial harmonization (OFH). We aimed to validate the FACE-Q SFAOS scale among professionals working with OFH and verify its acceptance for use in clinical practice. Altogether, 25 OFH specialists were included to evaluate the FACE-Q SFAOS scale and the new technology acceptability model (TAM). Internal validity was measured using Cronbach's α coefficient. Both scales were associated with clinical experience and perceived usefulness using Spearman's correlation and Fisher's exact or chi-square tests (SPSS 20.0, p < 0.05). The FACE-Q SFAOS (α = 0.927) and TAM (α = 0.941) scales demonstrated good internal validity, and most professionals demonstrated good acceptance (TAM >70 = 64%). The mean FACE-Q SFAOS and TAM scores were 64.00±17.03 and 74.60±20.66, respectively. Practitioners with more than two years of experience (p=0.032) who believed the scale was useful for lip filler evaluation (p = 0.017) demonstrated greater acceptance. The number of indications on the scale was directly correlated with higher levels of acceptance (p = 0.002, r = 0.594). Thus, the FACE-Q SFAOS scale has good reproducibility and acceptance among OFH specialists; however, acceptability was shown to be dependent on perceived usability.

Keywords: Esthetics; Dentistry; Surveys and Questionnaires; Validation Study

Variable		n (%)
Total		25
Sex
	Female	23 (92.0)
	Male	2 (8.0)
Age
	Up to 35 years old	13 (52.0)
	> 35 years old	12 (48.0)
Professional performance
	Private sector	22 (88.0)
	Secondary care	2 (8.0)
	Post-graduation teaching	4 (16.0)
	Higher education teaching	2 (8.0)
	Expert in facial harmonization	11 (44.0)
Expert time with facial harmonization
	Specialization in progess	15 (60.0)
	Up to 2 years	7 (28.0)
	> 2 years	3 (12.0)
Other specializations
	Orthodontics	11 (44.0)
	Implant	6 (24.0)
	Dentistry	6 (24.0)
	Functional jaw orthopedics	5 (20.0)
	Prothesis	2 (8.0)
	DTM	2 (8.0)
	CTBMF	2 (8.0)
	Endodontics	1 (4.0)
	Dental radiology	1 (4.0)
	Periodontics	1 (4.0)
	Odontogeriatry	1 (4.0)
	Collective health	1 (4.0)
Weekly routine of facial harmonization procedures
	Less than one per week	5 (20.0)
	1 or 2 procedures per week	8 (32.0)
	3 to 6 procedures per week	6 (24.0)
	7 or more procedures per week	6 (24.0)
TAM
	0 a 70%	8 (36.0)
	> 70%	17 (64.0)

Variable		Mean ± SD	Cronbach's α	Item correlation	Likert-like scale^d d Absolute frequency and percentage of Likert scale item;
Variable		Mean ± SD	Cronbach's α	With the scale^c c Spearman's correlation of the item analyzed with the total score of the questionnaire (0-100%);	1	2	3	4	5
FACE-Q SFAOS (0-100%)		64.00 ± 17.03	0.927^a a Cronbach's α of the questionnaire;
	1. How symmetrical does your face look?	2.80 ± 0.96	0.920^b b Cronbach's α of the item if it has been removed from questionnaire;	p < 0.001 (r = 0.762)	2 (8.0)	8 (32.0)	8 (32.0)	7 (28.0)	-
	2. How balanced does your face look?	2.92 ± 0.76	0.918^b b Cronbach's α of the item if it has been removed from questionnaire;	p < 0.001 (r = 0.829)	0 (0.0)	8 (32.0)	11 (44.0)	6 (24.0)	-
	3. How proportional does your face look?	2.80 ± 0.87	0.920^b b Cronbach's α of the item if it has been removed from questionnaire;	p < 0.001 (r = 0.785)	2 (8.0)	6 (24.0)	12 (48.0)	5 (20.0)	-
	4. How does your face look at the end of the day?	2.44 ± 0.87	0.919^b b Cronbach's α of the item if it has been removed from questionnaire;	p < 0.001 (r = 0.773)	3 (12.0)	11 (44.0)	8 (32.0)	3 (12.0)	-
	5. How fresh does your face look?	2.48 ± 1.05	0.911^b b Cronbach's α of the item if it has been removed from questionnaire;	p < 0.001 (r = 0.910)	5 (20.0)	8 (32.0)	7 (28.0)	5 (20.0)	-
	6. How rested does your face look?	2.32 ± 0.75	0.924^b b Cronbach's α of the item if it has been removed from questionnaire;	p < 0.001 (r = 0.641)	2 (8.0)	15 (60.0)	6 (24.0)	2 (8.0)	-
	7. How does your profile look (side view)?	2.48 ± 0.92	0.925^b b Cronbach's α of the item if it has been removed from questionnaire;	p < 0.001 (r = 0.691)	3 (12.0)	11 (44.0)	7 (28.0)	4 (16.0)	-
	8. How does your face look in photos?	2.48 ± 0.65	0.920^b b Cronbach's α of the item if it has been removed from questionnaire;	p < 0.001 (r = 0.800)	1 (4.0)	12 (48.0)	11 (44.0)	1 (4.0)	-
	9. How does your face look when you wake up?	2.24 ± 1.09	0.916^b b Cronbach's α of the item if it has been removed from questionnaire;	p < 0.001 (r = 0.836)	8 (32.0)	7 (28.0)	6 (24.0)	4 (16.0)	-
	10. How does your face look in bright (or strong) light?	2.64 ± 0.76	0.923^b b Cronbach's α of the item if it has been removed from questionnaire;	p < 0.001 (r = 0.751)	0 (0.0)	13 (52.0)	8 (32.0)	4 (16.0)	-
TAM (0-100%)		74.60 ± 20.66	0.941^a a Cronbach's α of the questionnaire;
	1. It seems to me a useful tool to evaluate the self-perception of facial esthetics?	3.76 ± 1.13	0.900^b b Cronbach's α of the item if it has been removed from questionnaire;	p < 0.001 (r = 0.923)	2 (8.0)	1 (4.0)	4 (16.0)	12 (48.0)	6 (24.0)
	2. I believe that the use of this tool can help in the identification and targeting of the main facial aesthetic problems in need of intervention?	3.76 ± 1.09	0.903^b b Cronbach's α of the item if it has been removed from questionnaire;	p < 0.001 (r = 0.882)	2 (8.0)	1 (4.0)	3 (12.0)	14 (56.0)	5 (20.0)
	3. Helped me to better understand the concepts related to facial esthetics?	3.56 ± 1.16	0.969^b b Cronbach's α of the item if it has been removed from questionnaire;	p < 0.001 (r = 0.870)	3 (12.0)	0 (0.0)	6 (24.0)	12 (48.0)	4 (16.0)
	4. I would use this tool in my routine care of patients with facial esthetic demands?	3.84 ± 1.11	0.914^b b Cronbach's α of the item if it has been removed from questionnaire;	p < 0.001 (r = 0.908)	2 (8.0)	0 (0.0)	5 (20.0)	11 (44.0)	7 (28.0)

Variable		TAM (0–100%)		p-value	FACE-Q SFAOS (0–100%)		p-value
Variable		0 a 70%	> 70%	p-value	0 a 70%	> 70%	p-value
Total		8 (36.0)	17 (64.0)	-	14 (66.0)	11 (44.0)	-
Sex
	Female	6 (75.0)	17 (100.0)	0.093	12 (85.7)	11 (100.0)	0.487
	Male	2 (25.0)	0 (0.0)		2 (14.3)	0 (0.0)
Age
	Up to 35 years old	5 (62.5)	8 (47.1)	0.673	6 (42.9)	7 (63.6)	0.428
	> 35 years old	3 (37.5)	9 (52.9)		8 (57.1)	4 (36.4)
Professional performance
	Private sector	6 (75.0)	16 (94.1)	0.231	11 (78.6)	11 (100.0)	0.230
	Secondary care	2 (25.0)	0 (0.0)	0.093	1 (7.1)	1 (9.1)	1.000
	Post-graduation teaching	3 (37.5)	1 (5.9)	0.081	4 (28.6)	0 (0.0)	0.105
	Higher education teaching	1 (12.5)	1 (5.9)	1.000	1 (7.1)	1 (9.1)	1.000
	Expert in facial harmonization	4 (50.0)	7 (41.2)	1.000	4 (28.6)	7 (63.6)	0.116
Expert time with facial harmonization
	Specialization in progess	4 (50.0)	11 (64.7)	0.389	11 (78.6)^* * p < 0.05, Fisher's exact test or Pearson's chi-square test (n, %).	4 (36.4)	0.032
	Up to 2 years	2 (25.0)	5 (29.4)		1 (7.1)	6 (54.5)^* * p < 0.05, Fisher's exact test or Pearson's chi-square test (n, %).
	> 2 years	2 (25.0)	1 (5.9)		2 (14.3)	1 (9.1)
Other specializations
	Orthodontics	6 (75.0)	5 (29.4)	0.081	5 (37.5)	6 (54.5)	0.435
	Implant	1 (12.5)	5 (29.4)	0.624	4 (28.6)	2 (18.2)	0.661
	Dentistry	0 (0.0)	6 (35.3)	0.129	2 (14.3)	4 (36.4)	0.350
	Functional jaw orthopedics	2 (25.0)	3 (17.6)	1.000	2 (14.3)	3 (27.3)	0.623
	Prothesis	0 (0.0)	2 (11.8)	1.000	2 (14.3)	0 (0.0)	0.487
	DTM	2 (25.0)	0 (0.0)	0.093	2 (14.3)	0 (0.0)	0.487
	CTBMF	2 (25.0)	0 (0.0)	0.093	2 (14.3)	0 (0.0)	0.487
	Endodontics	1 (12.5)	0 (0.0)	0.320	1 (7.1)	0 (0.0)	1.000
	Dental radiology	0 (0.0)	1 (5.9)	1.000	1 (7.1)	0 (0.0)	1.000
	Periodontics	0 (0.0)	1 (5.9)	1.000	1 (7.1)	0 (0.0)	1.000
	Odontogeriatry	0 (0.0)	1 (5.9)	1.000	1 (7.1)	0 (0.0)	1.000
	Collective health	1 (12.5)	0 (0.0)	0.320	0 (0.0)	1 (9.1)	0.440
Weekly routine of facial harmonization procedures
	Less than one per week	1 (12.5)	4 (23.5)	0.576	4 (28.6)	1 (9.1)	0.450
	1 or 2 procedures per week	3 (37.5)	5 (29.4)		5 (35.7)	3 (27.3)
	3 to 6 procedures per week	1 (12.5)	5 (29.4)		3 (21.4)	3 (27.3)
	7 or more procedures per week	3 (37.5)	3 (17.6)		2 (14.3)	4 (36.4)
TAM
	0 a 70%	-	-	-	5 (35.7)	3 (27.3)	1.000
	> 70%	-	-		9 (64.3)	8 (72.7)

Variable		Total	TAM (0–100%)		p-value	FACE-Q SFAOS (0–100%)		p-value
Variable		Total	0 a 70%	> 70%	p-value	0 a 70%	> 70%	p-value
The FACE-Q SFAOS scale can be useful for diagnosis and follow-up of
	Improvement of facial contours	22 (88.0)	6 (75.0)	16 (94.1)	0.231	13 (92.9)	9 (81.8)	0.565
	Orthognathic surgery	19 (76.0)	5 (62.5)	14 (82.4)	0.344	12 (85.7)	7 (63.6)	0.350
	Rhinomodeling	19 (76.0)	6 (75.0)	13 (76.5)	1.000	12 (85.7)	7 (63.6)	0.350
	Lip Filler	18 (72.0)	3 (37.5)	15 (88.2)^* * p < 0.05, Fisher's exact test or Pearson's chi-square test (n, %).	0.017	9 (64.3)	9 (81.8)	0.407
	Treatment for flaccidity	16 (64.0)	4 (50.0)	12 (70.6)	0.394	8 (57.1)	8 (72.7)	0.677
	Mandible maxilla advancement	16 (64.0)	3 (37.5)	13 (76.5)	0.087	9 (64.3)	7 (63.6)	1.000
	Jowl removal	15 (60.0)	3 (37.5)	12 (70.6)	0.194	8 (57.1)	7 (63.6)	1.000
	Botulinum toxin application	14 (56.0)	2 (25.0)	12 (70.6)	0.081	8 (57.1)	6 (54.5)	1.000
	Bichectomy	12 (48.0)	3 (37.5)	9 (52.9)	0.673	8 (57.1)	4 (36.4)	0.428
	Orthopedic facial treatment	12 (48.0)	2 (25.0)	10 (58.8)	0.202	8 (57.1)	4 (36.4)	0.428
	Blepharoplasty	12 (48.0)	2 (25.0)	10 (58.8)	0.202	9 (64.3)	3 (27.3)	0.111
	Facial slimming	12 (48.0)	2 (25.0)	10 (58.8)	0.202	6 (42.9)	6 (54.5)	0.695
	Labioplasty	11 (44.0)	2 (25.0)	9 (52.9)	0.234	10 (71.4)^* * p < 0.05, Fisher's exact test or Pearson's chi-square test (n, %).	1 (9.1)	0.004
	Treatment for spots and melasma	9 (36.0)	1 (12.5)	8 (47.1)	0.182	5 (35.7)	4 (36.4)	1.000
	Treatments for acne scars	7 (28.0)	1 (12.5)	6 (35.3)	0.362	4 (28.6)	3 (27.3)	1.000

Questões	Respostas
Questões	Muito insatisfeita	Pouco insatisfeita	Satisfeita	Muito satisfeita
a. Com o quanto seu rosto parece simétrico
b. Com o quanto seu rosto parece equilibrado
c. Com o quanto seu rosto parece proporcional
e. Com o quanto seu rosto parece fresco
f. Com o quanto seu rosto parece descansado
g. Com a aparência do seu perfil (vista lateral)
h. Com a aparência do seu rosto em fotos
i. Com a aparência do seu rosto ao acordar
j. Com a aparência do seu rosto sob luz intensa (ou forte)

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Sociedade Brasileira de Pesquisa Odontológica - SBPqO Av. Prof. Lineu Prestes, 2227, 05508-000 São Paulo SP - Brazil, Tel. (55 11) 3044-2393/(55 11) 9-7557-1244 - São Paulo - SP - Brazil
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[TFN1] ^a
Cronbach's α of the questionnaire;

[TFN2] ^b
Cronbach's α of the item if it has been removed from questionnaire;

[TFN3] ^c
Spearman's correlation of the item analyzed with the total score of the questionnaire (0-100%);

[TFN4] ^d
Absolute frequency and percentage of Likert scale item;

[TFN5] Likert-like FACE-Q SFAOS items: 1) Very dissatisfied, 2) Somewhat dissatisfied, 3) Somewhat satisfied, 4) Very satisfied; Likert scale TAM items: 1) Strongly Disagree, 2) Disagree, 3) Indifferent, 4) Agree, 5) Strongly Agree.