When the authors first began to investigate the use of botulinum toxin A in the glabella, they did not have a basis on which to build. No one had looked critically and intensively at the glabella before because the authors did not have effective treatment. The authors decided to use both subjective and objective measurements to evaluate botulinum toxin A treatment effectiveness. For the subjective measurements, the authors asked the study subjects the following simple question: “Giving marks on a scale of 0 to 7 (where 7 is the highest score with greatest correlation), how well did the result of the botulinum toxin injection accord with your expectations?”1 For an objective score, the authors graded the residual glabella line as smooth, improved, or no change. These measures have gradually improved over the years. The objective measure for botulinum toxin A evolved to a 4-point scale (none, mild, moderate, severe)2 to capture a greater range of severities. A crucial change was the addition of sample pictures of each grade, which allowed clinicians and their patients to discuss the clinical findings. At the same time that clinicians were using these scales for the measurement of clinical response, regulatory officials in many countries were asking penetrating questions about the validity of these scales and their ability to not only assess response to treatment but also to detect clinically meaningful differences.
Allergan created the first aesthetic scale to assess outcomes of treatment with botulinum toxin A approximately 20 years ago3 and has since developed and validated multiple scales to assess effectiveness and clinically meaningful differences after treatment with botulinum toxin A, dermal fillers, and other aesthetic treatments in different facial areas and in different ethnic groups.4–13 Using these validated scales, expert injectors can assess the response to treatment easily and accurately. Novice injectors have been able to use the sample pictures associated with each grade to render the clinical assessment of patients and their response to treatment more accurate.
The validated scales presented in this special issue of Dermatologic Surgery (sponsored by Allergan plc, Dublin, Ireland) are the latest in a long line of measures developed by Allergan to help clinicians and their patients better assess response to treatment. On behalf of the team that produced these validated scales, the authors trust you will find the scales useful in the management of your patients and the assessment of their treatment.
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