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A Validated Grading Scale for Marionette Lines

CARRUTHERS, ALASTAIR MD*; CARRUTHERS, JEAN MD; HARDAS, BHUSHAN MD; KAUR, MANDEEP MD, MS; GOERTELMEYER, ROMAN PHD; JONES, DEREK MD§; RZANY, BERTHOLD MD, PHD; COHEN, JOEL MD; KERSCHER, MARTINA MD, PHD#; FLYNN, TIMOTHY CORCORAN MD**; MAAS, COREY MD††; SATTLER, GERHARD MD‡‡; GEBAUER, ALEXANDER MD; POOTH, RAINER MD; MCCLURE, KATHLEEN RN; SIMONE-KORBEL, ULLI; BUCHNER, LARRY§§

Original Article
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BACKGROUND Melomental folds, or marionette lines, are one of the consequences of facial aging. The curvilinear wrinkles formed because of facial movements and the aging process extend downward from the oral commissures.

OBJECTIVES To develop the Marionette Lines Grading Scale for objective quantification of the severity of melomental folds and to establish the reliability of this photonumeric scale for clinical research and practice.

MATERIALS AND METHODS A 5-point photonumeric rating scale was developed to objectively quantify the severity of melomental folds. Nine experts rated photographs of 35 subjects, twice, with regard to marionette lines in comparison with morphed images. Inter- and intrarater variability was assessed by computing intraclass correlation coefficients.

RESULTS The agreement between the experts was high. Bubble plots (bivariate scatter plots) demonstrated linearity in judgment by the experts.

CONCLUSION The 5-point photonumeric scale generated spans the severity of marionette lines for which patients commonly seek correction. The scale is well stratified for consistent rating.

*Department of Dermatology and Skin Sciences, University of British Columbia, Vancouver, British Columbia, Canada; Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, British Columbia, Canada; Research and Development, Merz Pharmaceuticals, Greensboro, North Carolina; §Department of Dermatology, University of California at Los Angeles, California; Charité—Universitätsmedizin Berlin, Klinik für Dermatologie, Division of Evidence Based Medicine (dEBM), Berlin, Germany; AboutSkin Dermatology and DermSurgery, Englewood, and Department of Dermatology, University of Colorado, Denver, Colorado; #Division of Cosmetic Sciences University of Hamburg, Germany; **Department of Dermatology, University of North Carolina at Chapel Hill, and Cary Skin Center, Cary, North Carolina; ††Division of Facial Plastic and Reconstructive Surgery, University of California at San Francisco, California; ‡‡Rosenparkklinik GmbH, Darmstadt, Germany; §§Canfield Scientific, Fairfield, NJ

Address correspondence and reprint requests to: Alastair Carruthers, MD, Suite 820-943 West Broadway, Vancouver, British Columbia, Canada V5Z 4E1, or e-mail: alastair@carruthers.net

Drs. Alastair Carruthers, Jean Carruthers, Derek Jones, Berthold Rzany, Joel Cohen, Martina Kerscher, Timothy Corcoran Flynn, Corey Maas, and Gerhard Sattler are paid consultants to Merz Pharmaceuticals. Dr. Bhushan Hardas, Dr. Mandeep Kaur, Dr. Roman Goertelmeyer, Dr. Alexander Gebauer, Dr. Rainer Pooth, Kathleen McClure, and Ulli Simone-Korbel are employees of Merz Pharmaceuticals. Larry Buchner is an employee of Canfield Scientific.

© 2008 by the American Society for Dermatologic Surgery, Inc.
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