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.
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.
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.
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.
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: email@example.com
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.