title: A validated grading scale for forehead lines.
abstract: BACKGROUND
  As with other facial wrinkles, the gradual loss and disorganization of collagen fibers and elastin, connective tissues that provide underlying support for skin, cause horizontal forehead rhytides in large part.
  
  
  OBJECTIVE
  To develop the Forehead Lines Grading Scale for objective quantification of horizontal forehead rhytides at rest and with expression and to establish the reliability of this photonumeric scale for clinical research and practice.
  
  
  METHODS
  The Forehead Lines Grading Scale is a 5-point photonumeric rating scale that was developed to objectively quantify resting (static) and hyperkinetic (dynamic) forehead lines. Inter- and intrarater variability was assessed by computing intraclass correlation coefficients.
  
  
  RESULTS
  The agreement between the experts was highly significant. Bubble plots (bivariate scatter plots) demonstrated linearity in judgment by the experts.
  
  
  CONCLUSIONS
  The 5-point photonumeric scale generated spans the severity of forehead lines for which patients commonly seek correction. The scale is well stratified for consistent rating.
authors.affiliation: Department of Dermatology and Skin Sciences, University of British Columbia, Vancouver, British Columbia, Canada. alastair@carruthers.net
authors.forename: Alastair
authors.initials: A
authors.lastname: Carruthers
authors.forename: Jean
authors.initials: J
authors.lastname: Carruthers
authors.forename: Bhushan
authors.initials: B
authors.lastname: Hardas
authors.forename: Mandeep
authors.initials: M
authors.lastname: Kaur
authors.forename: Roman
authors.initials: R
authors.lastname: Goertelmeyer
authors.forename: Derek
authors.initials: D
authors.lastname: Jones
authors.forename: Berthold
authors.initials: B
authors.lastname: Rzany
authors.forename: Joel
authors.initials: J
authors.lastname: Cohen
authors.forename: Martina
authors.initials: M
authors.lastname: Kerscher
authors.forename: Timothy Corcoran
authors.initials: TC
authors.lastname: Flynn
authors.forename: Corey
authors.initials: C
authors.lastname: Maas
authors.forename: Gerhard
authors.initials: G
authors.lastname: Sattler
authors.forename: Alexander
authors.initials: A
authors.lastname: Gebauer
authors.forename: Rainer
authors.initials: R
authors.lastname: Pooth
authors.forename: Kathleen
authors.initials: K
authors.lastname: McClure
authors.forename: Ulli
authors.initials: U
authors.lastname: Simone-Korbel
authors.forename: Larry
authors.initials: L
authors.lastname: Buchner
mesh_terms: D004954:Esthetics / Q000145:classification*; D005260:Female; D005546:Forehead / Q000033:anatomy & histology*; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D008297:Male; D010781:Photography / Q000379:methods*; D015203:Reproducibility of Results; D015595:Skin Aging