Validated Assessment Scales for the Upper Face

Background Age‐related upper face changes such as wrinkles, lines, volume loss, and anatomic alterations may affect quality of life and psychological well‐being. The development of globally accepted tools to assess these changes objectively is an essential contribution to aesthetic research and routine clinical medicine. Objective To establish the reliability of several upper face scales for clinical research and practice: forehead lines, glabellar lines, crow's feet (at rest and dynamic expression), sex‐specific brow positioning, and summary scores of forehead and crow's feet areas and of the entire upper face unit. Methods and Materials Four 5‐point photonumerical rating scales were developed to assess glabellar lines and sex‐specific brow positioning. Twelve experts rated identical upper face photographs of 50 subjects in two separate rating cycles using all eight scales. Responses of raters were analyzed to assess intra‐ and interrater reliability. Results Interrater reliability was substantial for all upper face scales, aesthetic areas, and the upper face score except for the brow positioning scales. Intrarater reliability was high for all scales and resulting scores. Conclusion Except for brow positioning, the upper face rating scales are reliable tools for valid and reproducible assessment of the aging process.