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Validated Assessment Scales for the Upper Face

Flynn, Timothy C. MD1,2; Carruthers, Alastair MD3; Carruthers, Jean MD4; Geister, Thorin L. PhD5; Görtelmeyer, Roman PhD5; Hardas, Bhushan MD6; Himmrich, Silvia MSc5; Kerscher, Martina MD, PhD7; de Maio, Maurício MD8; Mohrmann, Cornelia MD5; Narins, Rhoda S. MD9,10; Pooth, Rainer MD, PhD5; Rzany, Berthold MD, ScM11; Sattler, Gerhard MD12; Buchner, Larry BA13; Benter, Ursula MSc9; Fey, Constanze PhD9; Jones, Derek MD15

doi: 10.1111/j.1524-4725.2011.02248.x
Original Articles

Background Age-related upper face changes such as wrinkles, lines, volume loss, and anatomic alterations may affect quality of life and psychological well-being. The development of globally accepted tools to assess these changes objectively is an essential contribution to aesthetic research and routine clinical medicine.

Objective To establish the reliability of several upper face scales for clinical research and practice: forehead lines, glabellar lines, crow's feet (at rest and dynamic expression), sex-specific brow positioning, and summary scores of forehead and crow's feet areas and of the entire upper face unit.

Methods and Materials Four 5-point photonumerical rating scales were developed to assess glabellar lines and sex-specific brow positioning. Twelve experts rated identical upper face photographs of 50 subjects in two separate rating cycles using all eight scales. Responses of raters were analyzed to assess intra- and interrater reliability.

Results Interrater reliability was substantial for all upper face scales, aesthetic areas, and the upper face score except for the brow positioning scales. Intrarater reliability was high for all scales and resulting scores.

Conclusion Except for brow positioning, the upper face rating scales are reliable tools for valid and reproducible assessment of the aging process.

1Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina,

2Cary Skin Center, Cary, North Carolina,

3Department of Dermatology and Skin Sciences, University of British Columbia, Vancouver, British Columbia, Canada

4Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, British Columbia, Canada

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

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

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

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

9Dermatology Surgery and Laser Center, New York, USA

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, University of California at Los Angeles, Los Angeles, California,

Address correspondence and reprint requests to: Timothy C. Flynn, MD, Cary Skin Center, 200 Wellesley Trade Lane, Cary, NC 27519, 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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