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Validated Assessment Scales for the Mid Face

Carruthers, Jean MD1; Flynn, Timothy C. MD2,3; Geister, Thorin L. PhD4; Görtelmeyer, Roman PhD4; Hardas, Bhushan MD5; Himmrich, Silvia MSc4; Jones, Derek MD6; Kerscher, Martina MD, PhD7; de Maio, Maurício MD8; Mohrmann, Cornelia MD3; Narins, Rhoda S. MD9,10; Pooth, Rainer MD, PhD4; Rzany, Berthold MD, ScM11; Sattler, Gerhard MD12; Buchner, Larry BA13; Benter, Ursula MSc14; Breitscheidel, Lusine MD, MPH14; Carruthers, Alastair MD, FRCPC15

doi: 10.1111/j.1524-4725.2011.02251.x
Original Articles

Background The improvement of aesthetic treatment options for age-related mid face changes, such as volume loss, and the increase in patient expectations necessitates the development of more-complex and globally accepted assessment tools.

Objective To develop three grading scales for objective assessment of the infraorbital hollow and upper and lower cheek fullness and to establish the reliability of these scales for clinical research and practice.

Methods and Materials Three 5-point rating scales were developed to assess infraorbital hollow and upper and lower cheek fullness objectively. Twelve experts rated identical mid face photographs of 50 subjects in two separate rating cycles using the mid face scales. Test responses of raters were analyzed to assess intra- and interrater reliability.

Results Interrater reliability was substantial for the infraorbital hollow, upper cheek fullness, and lower cheek fullness scales. Intrarater reliability was high for all three scales. Both of the cheek fullness scales yielded higher reliabilities when three rather than two views were used to assess the volume changes of the cheek.

Conclusion The mid face scales are reliable tools for valid and reproducible assessment of age-related mid face changes.

1Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, British Columbia, Canada

2Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina,

3Cary Skin Center, Cary, North Carolina,

4Research and Development, HQ MERZ Pharmaceuticals GmbH, Frankfurt, Germany

5Research and Development, MERZ Pharmaceuticals LLC, Greensboro, North Carolina,

6Department of Dermatology, University of California at Los Angeles, Los Angeles, California,

7Division of Cosmetic Sciences, University Hamburg, Hamburg, Germany

8Clinica Mauricio De Maio, Sao Paolo, SP, Brasil

9Dermatology Surgery and Laser Center, New York, New York,

10Department of Dermatology, New York University School of Medicine, New York, New York,

11Division of Evidence-Based Medicine, Klinik für Dermatologie, Charité – Universitätsmedizin Berlin, Berlin, Germany

12Rosenparkklinik, Darmstadt, Germany

13Canfield Scientific Inc, Fairfield, New Jersey,

14INC Research GmbH, Munich, Germany

15Department of Dermatology and Skin Sciences, University of British Columbia, Vancouver, British Columbia, Canada

Address correspondence and reprint requests to: Jean Carruthers, MD, 943 West Broadway, Suite 820, Vancouver, British Columbia, V5Z4E1, Canada, 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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