title: A validated grading scale for marionette lines.
abstract: 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.
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*; 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