A validated grading scale for marionette lines.
BACKGROUND
Melomental folds, or marionette lines, are one of the consequences of facial aging. The curvilinear wrinkles formed because of facial movements and the aging process extend downward from the oral commissures.


OBJECTIVE
To develop the Marionette Lines Grading Scale for objective quantification of the severity of melomental folds and to establish the reliability of this photonumeric scale for clinical research and practice.


METHODS
A 5-point photonumeric rating scale was developed to objectively quantify the severity of melomental folds. Nine experts rated photographs of 35 subjects, twice, with regard to marionette lines in comparison with morphed images. Inter- and intrarater variability was assessed by computing intraclass correlation coefficients.


RESULTS
The agreement between the experts was high. Bubble plots (bivariate scatter plots) demonstrated linearity in judgment by the experts.


CONCLUSIONS
The 5-point photonumeric scale generated spans the severity of marionette lines for which patients commonly seek correction. The scale is well stratified for consistent rating.
Carruthers
Alastair
A
Department of Dermatology and Skin Sciences, University of British Columbia, Vancouver, British Columbia, Canada. alastair@carruthers.net
Carruthers
Jean
J
Hardas
Bhushan
B
Kaur
Mandeep
M
Goertelmeyer
Roman
R
Jones
Derek
D
Rzany
Berthold
B
Cohen
Joel
J
Kerscher
Martina
M
Flynn
Timothy Corcoran
TC
Maas
Corey
C
Sattler
Gerhard
G
Gebauer
Alexander
A
Pooth
Rainer
R
McClure
Kathleen
K
Simone-Korbel
Ulli
U
Buchner
Larry
L
D004954:Esthetics / Q000145:classification*; D005145:Face / Q000033:anatomy & histology*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D008297:Male; D010781:Photography; D015203:Reproducibility of Results; D015595:Skin Aging