CC BY 4.0 · Facial Plast Surg 2024; 40(01): 036-045
DOI: 10.1055/a-2035-4468
Original Research

Pressure Masks for Facial Scar Treatment after Oncological Reconstruction: Long-Term Patient Satisfaction and Quality of Life

1   Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
2   GROW School of Oncology and Reproduction, Maastricht University, the Netherlands
Sander M.J. van Kuijk
3   Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Center, Maastricht, the Netherlands
Carlo Colla
1   Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
Eric Van den Kerckhove
1   Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
4   Department of Rehabilitation Sciences, Faber, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
5   Department of Physical Medicine and Rehabilitation and Burns Center, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
Rene R.W.J. Van der Hulst
1   Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
Andrzej Piatkowski
1   Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
6   Department of Plastic Surgery, VieCuri Medical Centrum, Venlo, the Netherlands
› Author Affiliations


Introduction With increasing incidence of facial skin cancer, more patients undergo facial reconstruction following Mohs micrographic surgery (MMS). Aesthetically unpleasing, thickened facial flaps, and disturbing scars can be treated with a pressure mask with inner silicone lining to help improve functional and aesthetic outcomes. However, data on long-term patient satisfaction and quality of life (QoL) following this treatment are lacking.

Methods We aimed to assess long-term satisfaction and QoL of patients who underwent local flap reconstruction following MMS. Patients treated between January 2012 and October 2020 were invited to answer FACE-Q and SCAR-Q questionnaires. Demographic data, skin cancer type and location, type of reconstruction, postoperative complications, duration of pressure mask therapy, daily compliance, and additional scar treatment were collected to explore possible predictors.

Results Of 92 eligible patients, 50 responded. Eighteen respondents were male (36%) and 32 were female (64%). Mean duration of pressure mask therapy was 10.20 ± 4.61 months. Patients were 61.14 ± 32.91 months after completion of pressure mask therapy upon participation. Patients whose reconstruction consisted of multiple flaps had significantly worse outcomes in social function (p = 0.012), scar appearance (p = 0.045), and scar symptoms (p = 0.008). A trend of increasing time since therapy completion predicting better outcomes was observed for all scales, and it was a significant predictor for better scar appearance (p = 0.001) and less scar symptoms (p = 0.001).

Conclusion Pressure mask treatment for facial flaps and scars following MMS results in good long-term patient satisfaction and QoL. Multiple local flaps, reflecting a larger skin defect postexcision, is a predictor for worse outcomes in social function, scar appearance, and symptoms. Increasing time is associated with increasing satisfaction, which reflects satisfactory and stable long-term effects of treatment, possibly combined with more acceptance of the result over time.

Publication History

Accepted Manuscript online:
14 February 2023

Article published online:
03 April 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

  • References

  • 1 Garbe C, Keim U, Gandini S. et al. Epidemiology of cutaneous melanoma and keratinocyte cancer in white populations 1943-2036. Eur J Cancer 2021; 152: 18-25
  • 2 Leiter U, Eigentler T, Garbe C. Epidemiology of skin cancer. Adv Exp Med Biol 2014; 810: 120-140
  • 3 Leiter U, Keim U, Garbe C. Epidemiology of skin cancer: update 2019. Adv Exp Med Biol 2020; 1268: 123-139
  • 4 Elleson KM, DePalo DK, Zager JS. An update on local and systemic therapies for nonmelanoma skin cancer. Expert Rev Anticancer Ther 2022; 22 (05) 479-489
  • 5 Hofer SO, Mureau MA. Improving outcomes in aesthetic facial reconstruction. Clin Plast Surg 2009; 36 (03) 345-354
  • 6 Brown BC, McKenna SP, Siddhi K, McGrouther DA, Bayat A. The hidden cost of skin scars: quality of life after skin scarring. J Plast Reconstr Aesthet Surg 2008; 61 (09) 1049-1058
  • 7 Sobanko JF, Sarwer DB, Zvargulis Z, Miller CJ. Importance of physical appearance in patients with skin cancer. Dermatol Surg 2015; 41 (02) 183-188
  • 8 van Leeuwen AC, The A, Moolenburgh SE, de Haas ER, Mureau MA. A retrospective review of reconstructive options and outcomes of 202 cases large facial Mohs micrographic surgical defects, based on the aesthetic unit involved. J Cutan Med Surg 2015; 19 (06) 580-587
  • 9 Kant SB, Ferdinandus PI, den Kerckhove EV. et al. A new treatment for reliable functional and esthetic outcome after local facial flap reconstruction: a transparent polycarbonate facial mask with silicone sheeting. Eur J Plast Surg 2017; 40 (05) 407-416
  • 10 Colla C, Kant SB, Van den Kerckhove E, Van der Hulst RR, Piatkowski de Grzymala AA. Manual fabrication of a specialized transparent facial pressure mask: a technical note. Prosthet Orthot Int 2019; 43 (03) 356-360
  • 11 Klassen AF, Cano SJ, Schwitzer JA, Scott AM, Pusic AL. FACE-Q scales for health-related quality of life, early life impact, satisfaction with outcomes, and decision to have treatment: development and validation. Plast Reconstr Surg 2015; 135 (02) 375-386
  • 12 Klassen AF, Cano SJ, Scott A, Snell L, Pusic AL. Measuring patient-reported outcomes in facial aesthetic patients: development of the FACE-Q. Facial Plast Surg 2010; 26 (04) 303-309
  • 13 Pusic AL, Klassen AF, Scott AM, Cano SJ. Development and psychometric evaluation of the FACE-Q satisfaction with appearance scale: a new patient-reported outcome instrument for facial aesthetics patients. Clin Plast Surg 2013; 40 (02) 249-260
  • 14 Klassen AF, Ziolkowski N, Mundy LR. et al. Development of a new patient-reported outcome instrument to evaluate treatments for scars: the SCAR-Q. Plast Reconstr Surg Glob Open 2018; 6 (04) e1672
  • 15 Ziolkowski NI, Pusic AL, Fish JS. et al. Psychometric findings for the SCAR-Q patient-reported outcome measure based on 731 children and adults with surgical, traumatic, and burn scars from four countries. Plast Reconstr Surg 2020; 146 (03) 331e-338e
  • 16 Kant SB, Colla C, Van den Kerckhove E, Van der Hulst RRWJ, Piatkowski de Grzymala A. Satisfaction with facial appearance and quality of life after treatment of face scars with a transparent facial pressure mask. Facial Plast Surg 2018; 34 (04) 394-399
  • 17 Klassen AF, Cano SJ, Pusic AL. FACE-Q satisfaction with appearance scores from close to 1000 facial aesthetic patients. Plast Reconstr Surg 2016; 137 (03) 651e-652e
  • 18 Huang R, Jiao H, Fan J. et al. Nanofat injection for the treatment of depressed facial scars. Aesthetic Plast Surg 2021; 45 (04) 1762-1771
  • 19 Herruer JM, Prins JB, van Heerbeek N, Verhage-Damen GWJA, Ingels KJAO. Does self-consciousness of appearance influence postoperative satisfaction in rhinoplasty?. J Plast Reconstr Aesthet Surg 2018; 71 (01) 79-84
  • 20 Elegbede A, Mermulla S, Diaconu SC. et al. Patient-reported outcomes in facial reconstruction: assessment of FACE-Q scales and predictors of satisfaction. Plast Reconstr Surg Glob Open 2018; 6 (12) e2004
  • 21 Ellis MA, Sterba KR, Brennan EA. et al. A systematic review of patient-reported outcome measures assessing body image disturbance in patients with head and neck cancer. Otolaryngol Head Neck Surg 2019; 160 (06) 941-954
  • 22 Kant S, van den Kerckhove E, Colla C, van der Hulst R, Piatkowski de Grzymala A. Duration of scar maturation: retrospective analyses of 361 hypertrophic scars over 5 years. Adv Skin Wound Care 2019; 32 (01) 26-34
  • 23 Bozec A, Schultz P, Gal J. et al. Evolution and predictive factors of quality of life in patients undergoing oncologic surgery for head and neck cancer: a prospective multicentric study. Surg Oncol 2019; 28: 236-242
  • 24 Zebolsky AL, Patel N, Heaton CM, Park AM, Seth R, Knott PD. Patient-reported aesthetic and psychosocial outcomes after microvascular reconstruction for head and neck cancer. JAMA Otolaryngol Head Neck Surg 2021; 147 (12) 1035-1044
  • 25 Ziolkowski NI, Behman R, Klassen AF. et al. Determining the independent risk factors for worse SCAR-Q scores and future scar revision surgery. Plast Reconstr Surg 2021; 148 (01) 203-212
  • 26 Miranda BH, Allan AY, Butler DP, Cussons PD. Scar revision surgery: the patient's perspective. Arch Plast Surg 2015; 42 (06) 729-734