Validated assessment scales for the lower face.
BACKGROUND
Aging in the lower face leads to lines, wrinkles, depression of the corners of the mouth, and changes in lip volume and lip shape, with increased sagging of the skin of the jawline. Refined, easy-to-use, validated, objective standards assessing the severity of these changes are required in clinical research and practice.


OBJECTIVE
To establish the reliability of eight lower face scales assessing nasolabial folds, marionette lines, upper and lower lip fullness, lip wrinkles (at rest and dynamic), the oral commissure and jawline, aesthetic areas, and the lower face unit.


METHODS
Four 5-point rating scales were developed to objectively assess upper and lower lip wrinkles, oral commissures, and the jawline. Twelve experts rated identical lower face photographs of 50 subjects in two separate rating cycles using eight 5-point scales. Inter- and intrarater reliability of responses was assessed.


RESULTS
Interrater reliability was substantial or almost perfect for all lower face scales, aesthetic areas, and the lower face unit. Intrarater reliability was high for all scales, areas and the lower face unit.


CONCLUSIONS
Our rating scales are reliable tools for valid and reproducible assessment of the aging process in lower face areas.
Department of Dermatology, New York University School of Medicine, 222 Westchester Avenue, White Plains, NY 10604, USA. rsnmd@worldnet.att.net
Rhoda S
RS
Narins
Jean
J
Carruthers
Timothy C
TC
Flynn
Thorin L
TL
Geister
Roman
R
Görtelmeyer
Bhushan
B
Hardas
Silvia
S
Himmrich
Derek
D
Jones
Martina
M
Kerscher
Maurício
M
de Maio
Cornelia
C
Mohrmann
Rainer
R
Pooth
Berthold
B
Rzany
Gerhard
G
Sattler
Larry
L
Buchner
Ursula
U
Benter
Lusine
L
Breitscheidel
Alastair
A
Carruthers
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D038622:Internationality; D007568:Jaw / Q000033:anatomy & histology* / Q000502:physiology; D008046:Lip / Q000033:anatomy & histology* / Q000502:physiology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D060052:Nasolabial Fold / Q000033:anatomy & histology* / Q000502:physiology / Q000601:surgery; D015588:Observer Variation; D056948:Orthognathic Surgical Procedures; D010781:Photography; D015203:Reproducibility of Results; D015361:Rhytidoplasty; D015595:Skin Aging / Q000502:physiology*