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Validated Assessment Scales for the Lower Face

Narins, Rhoda S. MD1; Carruthers, Jean MD2; Flynn, Timothy C. MD3,4; Geister, Thorin L. PhD5; Görtelmeyer, Roman PhD5; Hardas, Bhushan MD6; Himmrich, Silvia MSc5; Jones, Derek MD7; Kerscher, Martina MD, PhD8; de Maio, Maurício MD9; Mohrmann, Cornelia MD5; Pooth, Rainer MD, PhD5; Rzany, Berthold MD, ScM10; Sattler, Gerhard MD11; Buchner, Larry BA12; Benter, Ursula MSc13; Breitscheidel, Lusine MD, MPH13; Carruthers, Alastair MD14

doi: 10.1111/j.1524-4725.2011.02247.x
Original Articles

Background Aging in the lower face leads to lines, wrinkles, depression of the corners of the mouth, and changes in lip volume and lip shape, with increased sagging of the skin of the jawline. Refined, easy-to-use, validated, objective standards assessing the severity of these changes are required in clinical research and practice.

Objective To establish the reliability of eight lower face scales assessing nasolabial folds, marionette lines, upper and lower lip fullness, lip wrinkles (at rest and dynamic), the oral commissure and jawline, aesthetic areas, and the lower face unit.

Methods and Materials Four 5-point rating scales were developed to objectively assess upper and lower lip wrinkles, oral commissures, and the jawline. Twelve experts rated identical lower face photographs of 50 subjects in two separate rating cycles using eight 5-point scales. Inter- and intrarater reliability of responses was assessed.

Results Interrater reliability was substantial or almost perfect for all lower face scales, aesthetic areas, and the lower face unit. Intrarater reliability was high for all scales, areas and the lower face unit.

Conclusion Our rating scales are reliable tools for valid and reproducible assessment of the aging process in lower face areas.

1Department of Dermatology, New York University School of Medicine, New York, New York

2Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, British Columbia, Canada

3Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, USA

4Cary Skin Center, Cary, North Carolina,

5Research and Development HQ, MERZ Pharmaceuticals GmbH, Frankfurt, Germany

6Research and Development, MERZ Pharmaceuticals LLC, Greensboro, North Carolina,

7Department of Dermatology, University of California at Los Angeles, Los Angeles, California,

8Greensboro Division of Cosmetic Sciences, University Hamburg, Hamburg, Germany

9Clinica Mauricio De Maio, Sao Paolo, SP, Brasil

10Division of Evidence-Based Medicine, Klinik für Dermatologie, Charité – Universitätsmedizin Berlin, Berlin, Germany

11Rosenparkklinik, Darmstadt, Germany

12Canfield Scientific Inc., Fairfield, New Jersey,

13INC Research GmbH, Munich, Germany

14Department of Dermatology and Skin Sciences, University of British Columbia, Vancouver, British Columbia, Canada

Address correspondence and reprint requests to: Rhoda S. Narins, MD, Medical Director Dermatology Surgery and Laser Center New York, Clinical Professor of Dermatology New York University School of Medicine, 222 Westchester Avenue, Suite 300, White Plains, NY 10604, or e-mail:

Merz Pharmaceuticals GmbH provided funding for this study.

Drs. Alastair Carruthers, Jean Carruthers, Derek Jones, Maurício de Maio, Rhoda S. Narins, Berthold Rzany, Martina Kerscher, Timothy C. Flynn, and Gerhard Sattler are paid consultants to Merz Pharmaceuticals.

© 2012 by the American Society for Dermatologic Surgery, Inc.
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