OBJECTIVES: This research has been driven by the need for a quality of life (QoL) instrument that specifically assesses physical appearance. The BeautyQol instrument is a multi-dimensional, self administered questionnaire, which has been in development for over three years in 16 languages. METHODS: In the item generation phase, semi directive interviews were conducted in 309 subjects. In the second phase an acceptability study was conducted on 874 subjects in France, UK, Germany, Spain, Sweden, Italy, Russia, USA, Brazil, Japan, India (Hindi and English) China and South Africa (Zulu, Sotho and English). In the third phase, a total of 3231 subjects were recruited. to complete the BeautyQoL questionnaire, a skin clinical checklist, SF-36 and a socio-demographic questionnaire. A re-test has been carried out at 8 days on a subgroup of 652 subjects. The database was randomly divided into two subgroups and analyzed using a Rash analysis. Psychometric properties, construct validity, reproducibility, internal and external consistency were tested.  RESULTS: From the item generation phase, 62 questions were selected. General acceptability was very good in the 16 cultures, with a very low rate of no answers. The validation phase reduced the questionnaire in 44 questions structured in five dimensions explaining 76.7% of the total variance: Social Life, Self confidence, Psychological life, Vitality and Seduction. Internal consistency was high (Cronbach alpha coefficients between 0.932 and 0.978). Reproducibility at 8 days was satisfactory in all dimensions. External validity testing revealed that BeautyQol scores correlated significantly with all SF-36 scores except for Physical Function. Mean completion time was 7 minutes (median :5 minutes). CONCLUSIONS: These results demonstrate the validity and reliability of the BeautyQol questionnaire as the very first international instrument specific to physical appearance. It is expected that BeautyQoL will be an instrument that will measure QoL affected by cosmetic products, techniques and agents that alter physical appearance.