An interrater and intrarater reliability study of 3 photographic scales for the classification of perioral aesthetic features.
BACKGROUND
Validated aesthetic rating scales for the perioral area provide objective evaluations for clinical trials and practice.


OBJECTIVE
To confirm the reliability of 3 scales for evaluating dermal filler and neurotoxin treatments of the perioral area.


METHODS
Three lip-specific photographic scales were developed from standardized 2-dimensional images to evaluate Perioral Lines at Rest (POL), Oral Commissures (OCS), and Perioral Lines at Maximum Contraction (POLM) severity scales. Each 4-grade scale (none to severe) had 3 representative images per grade. Physician validators rated volunteers on each scale (2 rounds of live review). Volunteers provided 2 series of self-assessments. Physician and subject intrarater reliability were based on the comparison of round 1 and round 2 scores (mean weighted kappa coefficient). Other measures were physician interrater agreement (intraclass correlation) and subject/physician interrater agreement (Pearson correlation).


RESULTS
Physician intrarater agreement was almost perfect or substantial (POL, 0.725; OCS, 0.789; POLM, 0.826). Overall, physician interrater agreement was almost perfect for all 3 scales and ranged from moderate to substantial by grade. Subject intrarater agreement and subject/physician interrater agreement were substantial.


CONCLUSIONS
All scales demonstrated a high degree of intrarater and interrater reliability during the validation process. Physician concordance was good; subject ratings were reliable and comparable to physician assessments.
*Director, AboutSkin Dermatology and DermSurgery, Englewood, Colorado; †Allergan, Inc., Santa Barbara, California; ‡Assistant Clinical Professor of Medicine/Dermatology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; §Private Practice, Newport Beach, California; ‖Private Practice, Santa Barbara, California; ¶Allergan, Inc., Irvine, California; #SCI Scientific Communications and Information. J.T. and F.C.B. are in Kythera Biopharmaceuticals, Calabasas, California. P.S.W. Kythera Biopharmaceuticals, Agoura Hills, California.
Joel L
JL
Cohen
Jane
J
Thomas
Deepali
D
Paradkar
Adam
A
Rotunda
Patricia S
PS
Walker
Frederick C
FC
Beddingfield
Asha
A
Philip
Paula G
PG
Davis
Ramana
R
Yalamanchili
D001504:Beauty; D001672:Biocompatible Materials / Q000008:administration & dosage*; D003357:Cosmetic Techniques; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D007267:Injections; D008046:Lip / Q000187:drug effects* / Q000473:pathology*; D008875:Middle Aged; D009498:Neurotoxins / Q000008:administration & dosage*; D015588:Observer Variation; D010865:Pilot Projects; D015203:Reproducibility of Results; D018570:Risk Assessment; D012720:Severity of Illness Index; D015595:Skin Aging / Q000187:drug effects
D001672:Biocompatible Materials; D009498:Neurotoxins