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Creation and Validation of a Photonumeric Scale to Assess Volume Deficiency in the Infraorbital Region

Niforos, François MD*; Liew, Steven MBBS, FRACS; Acquilla, Raj MBChB, MRCGP, MBCAM; Ogilvie, Patricia MD, PhD§; Safa, Marva MD; Signorini, Massimo MD; Jones, Derek MD#; Hawthorn, Jan BSc, PhD**; Collins, Caroline BSc††; Kerson, Graeme BSc‡‡; Sithamparanathan, Myooran MBBS, MRCS, MFPM‡‡The AIRS Study Group

doi: 10.1097/DSS.0000000000001088
Original Article

BACKGROUND The eyes are particularly important aesthetic features of the face and revitalization of the infraorbital region has become a focus of aesthetic treatments. Published infraorbital scales to date have limitations in that they have been descriptive, subjective, or have used computer-generated images. Thus, there is an unmet need for a validated scale based on actual images.

OBJECTIVE To develop a practical photonumeric scale that respects the complex anatomy and age-related changes occurring in the orbital area.

METHODS AND MATERIALS The Allergan Infra-oRbital Scale (AIRS) was developed through a multistep process in collaboration with 16 physicians (plastic surgeons, dermatologists, and aesthetic physicians). Scale development involved both online photographs and live assessments of subjects. Interrater and intrarater reliability was assessed using intraclass correlation coefficients (ICCs).

RESULTS The final AIRS showed intrarater and interrater ICCs of 0.78 to 0.86 and 0.91 to 0.98 for live validation and 0.76 to 0.82 and 0.86 to 0.91 for online validation, respectively, demonstrating robust validity.

CONCLUSION The AIRS can be considered a photonumeric scale that accurately describes volume loss in the infraorbital region. It has been validated and is appropriate for use in research or for everyday clinical use for both live and photographic assessment.

*Centre Chirurgical Niforos, Lyon, France;

Shape Clinic, Sydney, Australia;

The Gatehouse, Cheshire, United Kingdom;

§Skin Concept, Munich, Germany;

La Jouvence, Neuchâtel, Switzerland;

Private Practice, Milano, Italy;

#Division of Dermatology, University of California at Los Angeles, Los Angeles, California;

**Collins Therapeutic Consulting Ltd, Gloucestershire, United Kingdom;

††Surrey, United Kingdom;

‡‡Allergan plc, Marlow, United Kingdom

Address correspondence and reprint requests to: Graeme Kerson, BSc, Allergan plc, 1st Floor, Marlow International Parkway, Marlow, Bucks SL7 1 YL, United Kingdom, or e-mail:

This project was sponsored by Allergan plc, Dublin, Ireland. Writing and editorial assistance was provided by J. Hawthorn, BSc, PhD, C. Collins, BSc, and Peloton Advantage and was funded by Allergan plc, Dublin, Ireland. The authors had their expenses paid by Allergan plc and were reimbursed for the time and traveling involved in validating the scale; neither honoraria nor payments were made for authorship.

The authors have indicated no significant interest with commercial supporters.

© 2017 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.
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