1
|
Farollch-Prats L, Braz A, Urdiales-Gálvez F, de la Guardia C, Nazari A. Profiloplasty and facial contouring with injectables: A holistic, practical, and user-friendly approach. J Cosmet Dermatol 2024. [PMID: 38769652 DOI: 10.1111/jocd.16375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 04/18/2024] [Accepted: 05/03/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Expansion of the aesthetic treatment armamentarium with novel injectable products has greatly improved our ability to reshape and enhance the facial profile. However, full-face "profiloplasty" with injectables remain a nascent concept and is insufficiently considered in daily practice. While techniques have been widely published for treating the individual facial areas that constitute an attractive profile-including the forehead, nose, lips, jawline, and chin-the literature remains fragmented on more universal methods for profile improvement. AIMS To collate disparate knowledge on profile optimization with injectables, and define a holistic, practical, and user-friendly approach to profiloplasty and facial contouring. METHODS Consideration is given to key anatomical aspects and the changes that occur with age; patient assessment parameters for planning profiloplasty; and the technical specifications, product selection, and essential safety considerations for minimizing the risk of complications and optimizing the effectiveness of treatment. RESULTS Relevant case studies are presented. CONCLUSIONS Holistic approaches of this type are essential if we are to maximize the potential of full-face treatment with injectables-both now and in the future.
Collapse
Affiliation(s)
| | - André Braz
- Dermatología Láser Cosmiatria Clinic, Rio de Janeiro, Brazil
| | | | - Carola de la Guardia
- Global Aesthetics Medical Affairs, Allergan Aesthetics, an AbbVie Company, Madrid, Spain
| | | |
Collapse
|
2
|
Dayan S, Green JB, Schlesinger T, Dimitrijevic E, Chawla S, Sangha S. Higher Responder Rates Observed With Live Participant Assessment Versus Photographic Assessment After VYC-20L Hyaluronic Acid Treatment for Chin Augmentation. Aesthet Surg J 2024; 44:527-536. [PMID: 37966371 PMCID: PMC10994201 DOI: 10.1093/asj/sjad348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 11/03/2023] [Accepted: 11/09/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND In an evaluator-blinded, randomized controlled trial, the hyaluronic acid soft-tissue filler VYC-20L injectable gel was safe and effective for correcting volume deficits and retrusion in the chin. OBJECTIVES The objective of this subanalysis was to compare responder rates obtained with photographic vs live assessments. METHODS Participants were randomized 3:1 to VYC-20L treatment or a 6-month, no-treatment control period followed by optional treatment. Responder rates (≥1-point improvement from baseline on the validated Allergan Chin Retrusion Scale [ACRS]) obtained with photographic assessments and live assessments at Month 6 were compared. Prespecified subgroup analyses compared responder rates by baseline ACRS severity, filler volume, cannula usage, and investigation site. RESULTS VYC-20L was effective for chin augmentation as evaluated with both live and photographic assessments. The ACRS responder rates at Month 6 were 91.8% with live assessments and 56.3% with photographic assessments. Consistently higher response rates were observed by live vs photographic assessment regardless of baseline ACRS severity, filler volume, cannula usage, and investigation site. CONCLUSIONS Live assessment of ACRS response after VYC-20L treatment resulted in higher responder rates than photographic assessment, supporting the use of live assessment for this indication to approximate real-world clinical practice. LEVEL OF EVIDENCE: 1
Collapse
Affiliation(s)
- Steven Dayan
- Corresponding Author: Dr Steven Dayan, DeNova Research, 845 N. Michigan Avenue, Suite 923E, Chicago, IL 60611, USA. E-mail:
| | | | | | | | | | | |
Collapse
|
3
|
Guo Y, Wang J, Wei W, Zhang A, Li Q, Tao C, Shen C, Wei H, Jin P. Treatment of Chin Retrusion With Botulinum Toxin Plus Hyaluronic Acid Filler in Comparison With Hyaluronic Acid Filler Alone: A Randomized, Evaluator-Blinded, Controlled Study. Aesthet Surg J 2024; 44:537-544. [PMID: 38036752 DOI: 10.1093/asj/sjad358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 11/14/2023] [Accepted: 11/29/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Hyaluronic acid (HA) has already been widely administered for chin augmentation. Patients with chin retrusion frequently present with increased chin hypertonia. Monotherapy with HA falls short in addressing the multifaceted cosmetic concerns associated with chin retrusion. OBJECTIVES This study aimed to investigate the clinical efficacy and safety of the combination therapy involving botulinum toxin (BTX) and HA in the treatment of chin retrusion. METHODS We enrolled patients with moderate to severe chin retrusion for 9 months of follow-up after they received either combined treatment with BTX plus HA or monotreatment with HA. We also calculated the surface-volume coefficient with 3-dimensional digital scanning technique, and evaluated outcomes based on the Allergan Chin Retrusion Scale (ACRS), the Global Aesthetic Improvement Scale (GAIS), and treatment-related adverse events (TRAEs). RESULTS A total of 50 patients were recruited and randomized to the treatment group (BTX plus HA) or control group (HA alone) in a 1:1 ratio. Patients in the treatment group exhibited significantly higher surface-volume coefficients during the first 6 months (P < .05). ACRS scores and responder rates in the 2 groups remained similar throughout the follow-up (P > .05). Within the initial 3 months, the GAIS responder rate in the treatment group was significantly higher than that in the control group (P < .05). Mild TRAEs were observed in both groups, and subsided within 7 days. There was no increase in adverse effects with the combined treatment. CONCLUSIONS In comparison to monotherapy, the combined treatment not only improved the surface-volume coefficient of hyaluronic acid but also achieved similar ACRS scores with less HA volume. Furthermore, the combination treatment yielded superior treatment outcomes for individuals with chin retrusion. LEVEL OF EVIDENCE: 2
Collapse
|
4
|
Guo X, Zong X, Song G, Zhao J, Lai C, Zhang D, Jin X. Would hyaluronic acid-induced mental bone resorption be a concern? A prospective controlled cohort study and an updated retrospective cohort study. Int J Surg 2024; 110:1502-1510. [PMID: 38181116 PMCID: PMC10942210 DOI: 10.1097/js9.0000000000000955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 11/21/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND Hyaluronic acid (HA) is a widely used filler for face contouring and is generally believed to be safe and effective. However, there have been reports of HA-related bone erosion in the chin area without clear scientific data regarding its existence, incidence, and severity. This exploratory study was to evaluate HA-related mental bone resorption through a prospective, controlled, observer-blind, nonrandomized clinical trial and a retrospective cohort study. METHODS On the one hand, a prospective, controlled, nonrandomized, single-shot HA-injection clinical trial was conducted. Computed tomographic scans were collected at baseline and at 6-12 months of follow-up for both HA-injection and control groups. On the other hand, an updated retrospective cohort study compared the HA-injection with a blank control group. The primary outcomes composed of three quantitative parameters [bone resorption index (BRI M and BRI N ), bone resorption thickness ratio] and one subjective evaluation index (severity ranking). Information about demographics, complications, and injection volume were also recorded. RESULTS From June 2021 to March 2023, 78 patients were prospectively recruited for the study. There was a significant association between HA-injection and bone resorption [BRI M : pre (84.24±8.10%) vs post (79.21±8.70%), P <0.001; BRI N : pre 92.50% (73, 144%) vs 87.99% (63, 132%), P <0.001; bone thickness ratio: HA 24.08% (0, 48%) vs control 0 (0, 17%), P <0.001]. However, there was no difference in large-volume (>1 ml) and small-volume (≦1 ml) injection subgroups [bone resorption thickness ratio: (21.50±10.91%) vs (24.51±11.92%), P =0.350]. The imaging manifestation revealed discernible bone resorption in 35.90% of the patients, with an median bone resorption thickness ratio of 24.08%. Between October of 2019 and March 2023, 95 HA-injection patients (190 semimandibular cases), 95 normal controls were enrolled. The BRI M was significantly lower in the HA-injection group compared to the controls ( P <0.001). CONCLUSIONS HA may induce bone resorption in the mentum. Large-scale randomized controlled clinical trial is warranted for further confirmation. Patients should be informed of this potential complication.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Xiaolei Jin
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| |
Collapse
|
5
|
Aesthetic Concerns of Chin Augmentation With Hyaluronic Acid Soft Tissue Filler in Chinese: A Prospective, Observational Study. Dermatol Surg 2023; 49:242-246. [PMID: 36728221 DOI: 10.1097/dss.0000000000003691] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The chin is an important facial structure that directly affects the overall contour of the face. The key to achieving a beautiful, effective, and safe chin injection is to make a good facial assessment and use an appropriate injection technique to achieve the best injection effect. OBJECTIVE In this article, the authors will discuss cosmetic concepts for the chin area and verify the effectiveness of chin augmentation techniques. MATERIALS AND METHODS Chin volume injections were performed on 23 Asian female subjects and 15 Asian male subjects. Demographic and imaging data were collected, and the facial aesthetic length was calculated. The authors also measured the length of beautiful chins, as evaluated by 2 plastic surgeons, and the ratios of chins from "The 100 Most Beautiful/Handsome Faces in China" published by TCC Asia in 2020. RESULTS The mean volume of chin filling was 1.89 ± 0.74 mL in female subjects and 2.68 ± 1.28 mL in male subjects. The ideal length of the chin was equal to that of the nasal dorsum in male subjects, and the ideal chin-to-nasal dorsum ratio was 0.9 in female subjects. CONCLUSION In this study, the authors investigate sex differences in chin aesthetics among the Chinese population and introduce an aesthetic and anatomical approach to chin injection.
Collapse
|
6
|
Braccini F, Fanian F, Garcia P, Delmar H, Loreto F, Benadiba L, Nadra K, Kestemont P. Comparative clinical study for the efficacy and safety of two different hyaluronic acid-based fillers with Tri-Hyal versus Vycross technology: A long-term prospective randomized clinical trial. J Cosmet Dermatol 2023; 22:473-485. [PMID: 35770300 PMCID: PMC10084174 DOI: 10.1111/jocd.15200] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/07/2022] [Accepted: 06/23/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Hyaluronic acid-based fillers have an immediate volumizing effect for the treatment of dermal contour deformities and to smooth dermal depressions formed by the loss of volume. A previous study on 2016-2018 has shown the efficacy and safety of the HA-based filler ART FILLER® Volume on the midface only, but not in a comparative manner. METHODS In this context, an 18 months prospective randomized single-blind study of the non-inferiority of ART FILLER® Volume versus the reference product Juvéderm Voluma® was performed on the midface, temple, and jawline, and non-comparative study on the chin. The efficacy and the longevity were evaluated for the selected face areas via dedicated clinical scoring systems after a single filler injection without any re-touch or re-injection. The short- and long-term adverse effects were also recorded. RESULTS The observations confirmed the non-inferiority of ART FILLER® Volume versus the reference product on the different injected areas. For both fillers, the beneficial effects on volumes restoration were maintained 18 months post-injection; however, these effects were diminished among the time. Furthermore, injections of Art Filler® Volume were well tolerated by the subjects and showed less acute side effects compared with the reference product that may be explained by a lower induction of inflammation.
Collapse
|
7
|
Abstract
BACKGROUND The assessment of the human body, whether for aesthetic or reconstructive purposes, is an inherently visual endeavor. Ideally, reproducible, prompt, and cost-effective systems of visual evaluation would exist that can provide validated assessments of the aesthetic endpoints of treatment. One method to accomplish a standardization of the appreciation of visual endpoints is the use of visual scales. The goal of this systematic review is to summarize and evaluate the use of validated visual scales within aesthetic medicine, dermatology, and plastic and reconstructive surgery. METHODS A literature search was performed with a defined search strategy and extensive manual screening process. The Medical Outcomes Trust guidelines for visual scales in medicine were used, with special attention paid to each study's validation metrics. The review process identified 44 publications with validation data of sufficient quality from an initial survey of 27,745 articles. All rating scales based on imaging other than standardized clinical photographs were excluded. RESULTS The review demonstrates that validated visual assessment in plastic surgery is incomplete. Within specific subfields of aesthetic medicine and dermatology, many of the ( n = 20) facial aging scales were well-validated and demonstrated high reliability. Publications ( n = 8) focused on the evaluation of facial clefts demonstrated heterogeneity in the methods of validation and in overall reliability. Within the areas of breast surgery ( n = 9), body contouring ( n = 2), and scarring ( n = 5), the scales were variable in the methods used and the validation procedures were diverse. Scales using a visual guide tended to have better interrater (kappa = 0.75) and intrarater reliability (kappa = 0.78), regardless of the specific area of interest. CONCLUSIONS The fields of aesthetic medicine, and aesthetic and reconstructive plastic surgery require assessment of visual states over time and between many observers. For these reasons, the development of validated and reliable methods of visual assessment are critical. Until recently, the use of these tools has been limited by their time-consuming nature and cost.
Collapse
|
8
|
de Maio M. The 7-point Shape and The 9-point Shape: An Innovative Nonsurgical Approach to Improve the Facial Shape. Facial Plast Surg 2022; 38:102-110. [PMID: 35114709 DOI: 10.1055/s-0041-1741499] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Treatment with injectable fillers is considered to be intrinsically associated with the understanding of facial anatomy and appropriate techniques. However, a more comprehensive understanding of facial structure is critical to improving facial shape. This article presents two Nonsurgical approaches developed from the MD Codes system denominated "The 7-point Shape" and "The 9-point Shape." Both techniques were designed to help create a more feminine and masculine look, respectively. The aim is to provide foundation for the midface (cheek) and contour for the lower face (chin and jawline) and indirectly improve the facial signs that patients usually focus on when looking for aesthetic treatment (lines, folds, jowls, double chin, etc.). The MD Codes platform aims to deliver an alternative to surgery with injectables. The 7-point Shape and The 9-point Shape may provide visible results immediately after treatment.
Collapse
|
9
|
Pooth R, Prinz V, Cajkovsky M, Green JB, Hernandez CA, Pavicic T, Mueller DS, Sattler S, Klepetko H, Fabi SG, Day D, Suwanchinda A, Cotofana S, Frank K. Validated 5-point photonumeric scales for the assessment of the jowls and chin. J Cosmet Dermatol 2021; 21:600-607. [PMID: 34902199 DOI: 10.1111/jocd.14661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 11/21/2021] [Accepted: 11/30/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objective of this investigation was to create and to examine the reproducibility and validity of 5-point photonumeric assessment scales that allow objective assessment of chin retrusion and jawline sagging using a digital and a live validation. MATERIAL AND METHODS Two new 5-point photonumeric scales created to assess chin projection and jawline sagging were validated by 12 experts in a digital validation and by 5 experts in a live validation setting. Intra-rater agreement and inter-rater agreement were assessed. RESULTS For the digital validation, an almost perfect intra-rater (Kappa: 0.89 [95% CI: 0.86-0.91]) and almost perfect inter-rater agreement in both sessions (Kappa: 0.80 [95% CI: 0.74-0.86] and 0.80 [95% CI: 0.74-0.86]) was achieved for the Croma Chin Projection Assessment Scale, while intra-rater agreement (Kappa: 0.88 [95% CI: 0.85-0.91]) was almost perfect for the Croma Jawline Sagging Assessment Scale and inter-rater agreement being substantial in the first session (Kappa: 0.76 [95% CI: 0.71-0.81]) and almost perfect in the second session (Kappa: 0.81 [95%CI: 0.76-0.85]). For the live validation, intra-rater agreement was almost perfect for the Croma Chin Projection Assessment Scale (Kappa: 0.82 [95%CI: 0.74-0.90]) and the Croma Jawline Sagging Assessment Scale (Kappa: 0.83 [95%CI: 0.77-0.89]), while inter-rater agreement was substantial in both sessions for both scales. CONCLUSION The created chin and jawline photonumeric grading scales are valid and reliable tools for assessing chin projection and jawline sagging. The scales will be of value for standardized chin evaluation and quantifying outcomes in clinical research and daily practice.
Collapse
Affiliation(s)
- Rainer Pooth
- ICA Aesthetic Navigation GmbH, Frankfurt, Germany
| | | | | | - Jeremy B Green
- Skin Associates of South Florida, Skin Research Institute, Coral Gables, Florida, USA
| | | | - Tatjana Pavicic
- Private Practice for Dermatology & Aesthetics Dr. Tatjana Pavicic, Munich, Germany
| | | | | | | | | | - Doris Day
- Private Practice, New York City, New York, USA
| | - Atchima Suwanchinda
- Faculty of Medicine, Division of Dermatology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sebastian Cotofana
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Konstantin Frank
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig - Maximilian University Munich, Munich, Germany
| |
Collapse
|
10
|
Sakuma TH, Hirano CF, Braz AV. How to Project or Lengthen the Chin With Soft Tissue Fillers Respecting Sexual Dimorphism. Dermatol Surg 2021; 47:1524-1525. [PMID: 34468409 DOI: 10.1097/dss.0000000000003230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
11
|
Cassuto D, Pellacani G, Tateo A, Artzi O, Ingallina FM, Salti G, Rossi E, Lanzarotti A, Laouedj M, Dapis N, Bellia G. Development and Validation of IBSA Photographic Scale for the Assessment of Inner Upper Arm Laxity. Clin Cosmet Investig Dermatol 2021; 14:1465-1471. [PMID: 34675583 PMCID: PMC8520415 DOI: 10.2147/ccid.s317857] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 09/22/2021] [Indexed: 11/23/2022]
Abstract
Objective To describe the development and validation of the 5-grade photographic IBSA inner upper arm scale. Methods From 2 real-life pictures, a scale made up of 5 morphed images showing increasing severity of inner upper arm laxity was created. For validation, a set of 50 images (half of which real and the other morphed) was developed and sent to 5 trained physicians in two rounds 30 days apart. Raters’ task was to make a selection of each image according to the given scale. Inter-rater and intra-rater reliability were evaluated in both rounds. Results As to intra-rater reliability, single-rater kappa scores between 0.74 and 1.00 and a global kappa score of 0.846 were observed, while inter-rater agreement was calculated with intra-class correlation coefficient reporting scores higher than 0.91, which indicate excellent reliability. Conclusion IBSA inner upper arm laxity scale proved to be a validated and reliable tool.
Collapse
Affiliation(s)
| | - Giovanni Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Ofir Artzi
- Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | | | | - Elena Rossi
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | | | | |
Collapse
|
12
|
Lorenc ZP, Jones D, Kim J, Gwak HM, Batham S, Vachon G. Validating a Series of Photonumeric Rating Scales for Use in Facial Aesthetics Using Statistical Analysis of Intra- and Inter-rater Reliability. Aesthet Surg J Open Forum 2021; 3:ojab039. [PMID: 35350387 PMCID: PMC8958901 DOI: 10.1093/asjof/ojab039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Growing demand for minimally invasive aesthetic procedures to correct age-related facial changes and optimize facial proportions has been met with innovation but has created an unmet need for objective assessment tools to evaluate results empirically. Objectives The purpose of this study is to establish the intra- and inter-rater reliability of ordinal, photonumeric, 4-, or 5-point rating scales for clinical use to assess facial aesthetics. Methods Board-certified plastic surgeons and dermatologists (3 raters) performed live validation of jawline contour, temple volume, chin retrusion, nasolabial folds, vertical perioral lip lines, midface volume loss, lip fullness, and crow's feet dynamic- and at rest-rating scales over 2 rounds, 2 weeks apart. Subjects selected for live validation represented the range of scores and included 54 to 83 subjects for each scale. Test-retest reliability was quantitated through intra- and inter-rater reliability, determined from the mean weighted kappa and round 2 intraclass correlation coefficients, respectively. The clinical significance of a 1-grade difference was assessed through rater comparison of 31 pairs of side-by-side photographs of subjects with the same grade or a different grade on the developed scales. Results The study demonstrated substantial to near-perfect intra- and inter-rater reliability of all scales when utilized by trained raters to assess a diverse group of live subjects. Furthermore, the clinical significance of a 1-point difference on all the developed scales was established. Conclusions The high test-retest reliability and intuitive layout of these scales provide an objective approach with standardized ratings for clinical assessment of various facial features.
Collapse
Affiliation(s)
- Z Paul Lorenc
- Corresponding Author: Dr Z. Paul Lorenc, 983 Park Avenue, New York, NY 10028, USA. E-mail:
| | | | | | | | | | | |
Collapse
|
13
|
Abstract
ABSTRACT Chin augmentation procedures are gaining in popularity. The purpose of this study was to validate the China (Allergan) Chin Retrusion Scale (CACRS) and to evaluate the reliability of the scale. A team of 10 physicians based in Beijing, China, consisting of 1 principal investigator and 9 independent raters, assessed a pool of subject images. Using standardized equipment to capture 2-dimensional images, 100 subjects were photographed from a left, lateral, 90° view. Two measures were used to assess the validity of the scale: rater evaluations of clinically significant differences in 52 pairs of images and rater assessment of chin retrusion using the CACRS to grade the 100 images. The CACRS demonstrated almost perfect inter-rater agreement during 2 validation sessions, with intraclass correlation coefficients of 0.89 and 0.90 at sessions 1 and 2, respectively. Overall inter-rater agreement for all 9 raters was almost perfect, with a weighted kappa of 0.82. Based on inter- and intra-rater agreement, the CACRS was validated for physician ratings of chin retrusion in Chinese subjects. Results from clinical significance evaluations indicated that a 1-grade difference between image pairs was considered clinically meaningful for the CACRS. The CACRS is a validated and reliable photonumeric scale for the assessment of chin retrusion in Chinese men and women. The scale is a clinically significant reference tool for evaluating the effect of chin augmentation.
Collapse
|
14
|
Calvisi L, Palazzolo D, Triolo A. Nonsurgical reshaping of the nose, chin, and jawline: A retrospective analysis using experience-based eligibility criteria. J Cosmet Dermatol 2021; 21:1436-1444. [PMID: 34129737 DOI: 10.1111/jocd.14294] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 06/04/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Nonsurgical reshaping of the nose, chin, and jawline with hyaluronic acid fillers is becoming increasingly popular. Appropriate patient selection is essential. OBJECTIVES To assess the safety and efficacy of nonsurgical treatment of these facial areas using experience-based eligibility criteria and injection of the high G' filler, VYC-25L. METHODS This was a retrospective analysis of patients undergoing aesthetic improvement of the nose, chin, and/or jawline with VYC-25L, selected based on detailed criteria derived from extensive experience and imaging assessments. In a subgroup of subjects, high-resolution 3D imaging was used to assess nasal angles, nasal hump height, and chin projection. RESULTS A total of 135 patients were included (n = 106 females; mean age, 43.4 ± 14.3 years; n = 44 nose treatment only, n = 24 chin/jawline only, n = 67 both). Mean treatment volume was 3.3 ± 2.0 ml. In total, 111 individuals (82.2%) were injected in the nose (mean volume: 0.9 ± 0.2 ml) and 91 (67.4%) in the chin/jawline (mean volume: 3.8 ± 0.8 ml). Most complications were injection site-related (bruising, n = 27 [20.0%]; pain, n = 1 [0.7%]). One patient (0.7%) experienced lip herpes, successfully managed with antiviral therapy. Thirty-two individuals underwent 3D imaging, which showed substantial mean changes from baseline in nasofrontal angle (3.5 ± 1.6 degrees), nasofacial angle (2.2 ± 0.8 degrees), and nasolabial angle (3.9 ± 2.6 degrees); decreases in nasal hump height (1.7 ± 0.9 mm); and increased chin projection (2.7 ± 1.5 mm). CONCLUSIONS Nonsurgical reshaping of the nose, chin, and jawline was safe and effective using experience-based eligibility criteria and VYC-25L.
Collapse
|
15
|
Tateo A, Siquier-Dameto G, Artzi O, Humzah D, Molina B, Jain R, Lanzarotti A, Laouedj M, Dapis N, Bellia G. Development and Validation of IBSA Photographic Scale for the Assessment of Neck Laxity. Clin Cosmet Investig Dermatol 2021; 14:349-354. [PMID: 33854352 PMCID: PMC8039046 DOI: 10.2147/ccid.s302860] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 03/16/2021] [Indexed: 12/02/2022]
Abstract
Objective To describe the development and validation of the 5-grade photographic IBSA Neck Laxity Scale. Methods The scale was developed from 2 real images, which led to the creation of 5 morphed images, representing different degrees of severity of laxity of the neck. For validation, a set of 50 images (25 real and 25 morphed) was created and sent for evaluation to 6 trained raters (physicians) in 2 rounds, 1 month apart. Raters had to assess each image according to the 5-image scale. Inter-rater and intra-rater reliability in both rounds was evaluated. Results As to intra-rater reliability, single rater kappa scores between 0.69 and 0.87, and a global kappa score of 0.78 were observed. Inter-rater agreement was measured by means of the intra-class correlation coefficient and scores higher than 0.85 were reported, indicating excellent reliability. Conclusion IBSA Neck Laxity Scale is a validated and reliable scale.
Collapse
Affiliation(s)
| | - Gabriel Siquier-Dameto
- Private Practice, Amsterdam, the Netherlands.,Private Practice, Mallorca, Spain.,Research Group of Clinical Anatomy, Embryology and Neuroscience (NEOMA), Department of Medical Sciences, Universitat de Girona (UdG), Girona, Spain
| | - Ofir Artzi
- Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | | | | | | - Arturo Lanzarotti
- Research & Development, IBSA Institut Biochimique SA, Lugano, Switzerland
| | | | - Nicolas Dapis
- Business Development, Quantificare SA, Valbonne, France
| | | |
Collapse
|
16
|
Moradi A, Lin X, Allen S, Fagien S, Norberg M, Smith S. Validation of Photonumeric Assessment Scales for Temple Volume Deficit, Infraorbital Hollows, and Chin Retrusion. Dermatol Surg 2019; 46:1148-1154. [DOI: 10.1097/dss.0000000000002269] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
17
|
Validated Assessment Scales for Cellulite Dimples on the Buttocks and Thighs in Female Patients. Dermatol Surg 2019; 45 Suppl 1:S2-S11. [DOI: 10.1097/dss.0000000000001993] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
18
|
Role of Nonsurgical Chin Augmentation in Full Face Rejuvenation: A Review and Our Experience. Dermatol Surg 2018; 44:985-993. [PMID: 29309340 DOI: 10.1097/dss.0000000000001461] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The chin is a critical component to the perception of facial attractiveness. Dermal fillers offer a nonsurgical, temporary method of correcting mild to moderate chin retrusion and resorption. Thus far, discussion of this procedure has been largely limited to the plastic surgery and otolaryngology literature. OBJECTIVE To review pertinent aspects of anatomy, patient evaluation, injection technique, concomitant therapies, and complications in chin augmentation using injectable fillers. METHODS A brief review of the literature surrounding chin augmentation using injectable fillers, as well as the authors' experience in this area, is provided. RESULTS Chin augmentation using injectable fillers can be performed effectively and safely with adequate background knowledge of the regional anatomy and appropriate patient selection. The authors discuss both injection techniques in the published literature and their own approach. Potential complications and concomitant therapies are also reviewed. CONCLUSION As chin augmentation is increasingly recognized as an essential component to complete facial aesthetic rejuvenation, dermatologic surgeons should be familiar with how to safely and effectively perform augmentation with injectable fillers to achieve an optimal cosmetic outcome.
Collapse
|
19
|
Abstract
BACKGROUND A validated scale is needed for objective and reproducible comparisons of horizontal neck lines before and after treatment in practice and clinical studies. OBJECTIVE To describe the development and validation of the 5-point photonumeric Allergan Transverse Neck Lines Scale. METHODS The Allergan Transverse Neck Lines Scale was developed to include an assessment guide, verbal descriptors, morphed images, and real subject images for each scale grade. The clinical significance of a 1-point score difference was evaluated in a review of multiple image pairs representing varying differences in severity. Interrater and intrarater reliability was evaluated in a live-subject rating validation study (N = 297) completed during 2 sessions occurring 3 weeks apart. RESULTS A difference of ≥1 point on the scale was shown to reflect a clinically significant difference (mean [95% confidence interval] absolute score difference, 1.22 [1.09–1.35] for clinically different image pairs and 0.57 [0.42–0.72] for not clinically different pairs). Intrarater agreement between the 2 live-subject rating validation sessions was substantial (mean weighted kappa = 0.78). Interrater agreement was substantial during the second rating session (0.73, primary end point). CONCLUSION The Allergan Transverse Neck Lines Scale is a validated and reliable scale for rating of severity of neck lines.
Collapse
|
20
|
Jones D, Donofrio L, Hardas B, Murphy DK, Carruthers J, Carruthers A, Sykes JM, Creutz L, Marx A, Dill S. Development and Validation of a Photonumeric Scale for Evaluation of Volume Deficit of the Hand. Dermatol Surg 2017; 42 Suppl 1:S195-S202. [PMID: 27661741 PMCID: PMC5671787 DOI: 10.1097/dss.0000000000000850] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND A validated scale is needed for objective and reproducible comparisons of hand appearance before and after treatment in practice and clinical studies. OBJECTIVE To describe the development and validation of the 5-point photonumeric Allergan Hand Volume Deficit Scale. METHODS The scale was developed to include an assessment guide, verbal descriptors, morphed images, and real-subject images for each grade. The clinical significance of a 1-point score difference was evaluated in a review of image pairs representing varying differences in severity. Interrater and intrarater reliability was evaluated in a live-subject validation study (N = 296) completed during 2 sessions occurring 3 weeks apart. RESULTS A score difference of ≥1 point was shown to reflect a clinically significant difference (mean [95% confidence interval] absolute score difference, 1.12 [0.99–1.26] for clinically different image pairs and 0.45 [0.33–0.57] for not clinically different pairs). Intrarater agreement between the 2 validation sessions was almost perfect (mean weighted kappa = 0.83). Interrater agreement was almost perfect during the second session (0.82, primary end point). CONCLUSION The Allergan Hand Volume Deficit Scale is a validated and reliable scale for physician rating of hand volume deficit.
Collapse
Affiliation(s)
- Derek Jones
- *Division of Dermatology, University of California at Los Angeles, Los Angeles, California; †Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut; ‡Allergan plc, Irvine, California; Departments of §Ophthalmology and Visual Sciences, and ‖Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada; ¶UC Davis Medical Group, Sacramento, California; #Peloton Advantage, LLC, Parsippany, New Jersey
| | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Development and Validation of a Photonumeric Scale for Evaluation of Static Horizontal Forehead Lines. Dermatol Surg 2017; 42 Suppl 1:S243-S250. [PMID: 27661747 PMCID: PMC5671802 DOI: 10.1097/dss.0000000000000855] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
BACKGROUND A validated scale is needed for objective and reproducible comparisons of static forehead lines before and after treatment in practice and clinical studies. OBJECTIVE To describe the development and validation of the 5-point photonumeric Allergan Forehead Lines Scale. METHODS The Allergan Forehead Lines Scale was developed to include an assessment guide, verbal descriptors, morphed images, and real subject images for each scale grade. The clinical significance of a 1-point score difference was evaluated in a review of multiple image pairs representing varying differences in severity. Interrater and intrarater reliability was evaluated in a live-subject validation study (N = 295) completed during 2 sessions occurring 3 weeks apart. RESULTS A difference of ≥1 point on the scale was shown to reflect a clinically significant difference (mean [95% confidence interval] absolute score difference, 1.06 [0.91–1.21] for clinically different image pairs and 0.38 [0.26–0.51] for not clinically different pairs). Intrarater agreement between the 2 live-subject validation sessions was almost perfect (mean weighted kappa = 0.87). Interrater agreement was almost perfect during the second rating session (0.86, primary end point). CONCLUSION The Allergan Forehead Lines Scale is a validated and reliable scale for physician rating of static horizontal forehead lines.
Collapse
|
22
|
Abstract
BACKGROUND A validated scale is needed for objective and reproducible comparisons of facial skin roughness before and after aesthetic treatment in practice and in clinical studies. OBJECTIVE To describe the development and validation of the 5-point photonumeric Allergan Skin Roughness Scale. METHODS The scale was developed to include an assessment guide, verbal descriptors, morphed images, and real subject images for each grade. The clinical significance of a 1-point score difference was evaluated in a review of image pairs representing varying differences in severity. Interrater and intrarater reliability was evaluated in a live-subject validation study (N = 290) completed during 2 sessions occurring 3 weeks apart. RESULTS A score difference of ≥1 point was shown to reflect a clinically meaningful difference (mean [95% confidence interval] absolute score difference 1.09 [0.96–1.23] for clinically different image pairs and 0.53 [0.38–0.67] for not clinically different pairs). Intrarater agreement between the 2 validation sessions was almost perfect (weighted kappa = 0.83). Interrater agreement was almost perfect during the second rating session (0.81, primary end point). CONCLUSION The Allergan Skin Roughness Scale is a validated and reliable scale for physician rating of midface skin roughness.
Collapse
|
23
|
Korgavkar K, Lee KC, Weinstock MA. Effect of Topical Fluorouracil Cream on Photodamage: Secondary Analysis of a Randomized Clinical Trial. JAMA Dermatol 2017; 153:1142-1146. [PMID: 28877312 DOI: 10.1001/jamadermatol.2017.2578] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Photoaging, which is premature skin aging caused by long-term UV exposure, is of aesthetic concern to many patients. Objective To investigate the effect of topical fluorouracil, 5%, cream on photoaging using validated photonumeric scales. Design, Setting, and Participants The Veterans Affairs Keratinocyte Carcinoma Chemoprevention Trial was a randomized clinical trial of 932 US veterans with a recent history of 2 or more keratinocyte carcinomas performed from September 30, 2011, through June 30, 2014, to assess the chemopreventive effects of a standard course of topical fluorouracil. Photographs were taken at baseline and at numerous time points for up to 4 years. In our secondary analysis, 2 independent dermatologists graded these photographs using 4 validated photonumeric scales. A total of 3042 photographs from 281 participants randomized to apply topical fluorouracil or placebo were evaluated at baseline, 6 months, 12 months, and 18 months using 4 photonumeric scales (Griffiths scale, Allergan forehead lines scale, melomental folds scale, and crow's feet scale). Data analysis was performed from November 1, 2016, to January 1, 2017. Interventions Participants were randomized to apply topical fluorouracil, 5%, cream or a vehicle control cream to the face and ears twice daily for 2 to 4 weeks for a total of 28 to 56 doses. Main Outcomes and Measures Effect of a standard course of fluorouracil on the extent of photodamage as measured using 4 photonumeric scales. Results The study population was predominantly male (274 [97.5%]) and white (281 [100%]), with a mean (SD) age of 71.5 (0.57) years. No statistically significant changes were found in photodamage between baseline and 6 months (Griffiths scale: χ2 = 0.01, P = .93; Allergan forehead lines scale: χ2 = 0.18, P = .67; melomental fold scale: χ2 = 0.03, P = .87; crow's feet scale: χ2 = 2.41, P = .12), 12 months (Griffiths scale: χ2 = 1.39, P = .24; Allergan forehead lines scale: χ2 = 0.64, P = .43; melomental fold scale: χ2 = 0.12, P = .73; crow's feet scale: χ2 = 1.07, P = .30), and 18 months (Griffiths scale: χ2 = 3.11, P = .08; Allergan forehead lines scale: χ2 = 0.89, P = .34; melomental fold scale: χ2 = 1.64, P = .20; crow's feet scale: χ2 = 0.46, P = .50). Conclusions and Relevance This study did not demonstrate improvement in photoaging with a standard course of topical fluorouracil, 5%, cream, a finding that may be attributable to a true lack of effect in photodamage or limitations of the photonumeric scales in capturing the effect. The development of photonumeric scales that include manifestations of photoaging other than rhytids, such as lentigines, hyperpigmentation, and telangiectasias, should be considered. Trial Registration clinicaltrials.gov Identifier: NCT00847912.
Collapse
Affiliation(s)
- Kaveri Korgavkar
- Department of Dermatology, Brown University, Providence, Rhode Island
| | - Kachiu C Lee
- Department of Dermatology, Brown University, Providence, Rhode Island
| | - Martin A Weinstock
- Department of Dermatology, Brown University, Providence, Rhode Island.,Dermatoepidemiology Unit, Veterans Affairs Medical Center, Providence, Rhode Island
| | | |
Collapse
|
24
|
Carruthers J, Jones D, Hardas B, Murphy DK, Donofrio L, Sykes JM, Carruthers A, Creutz L, Marx A, Dill S. Development and Validation of a Photonumeric Scale for Evaluation of Volume Deficit of the Temple. Dermatol Surg 2016; 42 Suppl 1:S203-S210. [PMID: 27661742 PMCID: PMC5671790 DOI: 10.1097/dss.0000000000000848] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND A validated scale is needed for objective and reproducible comparisons of temple appearance before and after aesthetic treatment in practice and clinical studies. OBJECTIVE To describe the development and validation of the 5-point photonumeric Allergan Temple Hollowing Scale. METHODS The scale was developed to include an assessment guide, verbal descriptors, morphed images, and real subject images for each grade. The clinical significance of a 1-point score difference was evaluated in a review of image pairs representing varying differences in severity. Interrater and intrarater reliability was evaluated in a live-subject validation study (N = 298) completed during 2 sessions occurring 3 weeks apart. RESULTS A score difference of ≥1 point was shown to reflect a clinically significant difference (mean [95% confidence interval] absolute score difference, 1.1 [0.94-1.26] for clinically different image pairs and 0.67 [0.51-0.83] for not clinically different pairs). Intrarater agreement between the 2 validation sessions was almost perfect (mean weighted kappa = 0.86). Interrater agreement was almost perfect during the second session (0.81, primary endpoint). CONCLUSION The Allergan Temple Hollowing Scale is a validated and reliable scale for physician rating of temple volume deficit.
Collapse
Affiliation(s)
- Jean Carruthers
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Derek Jones
- Division of Dermatology, University of California at Los Angeles, Los Angeles, California
| | | | | | - Lisa Donofrio
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
| | | | - Alastair Carruthers
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lela Creutz
- Peloton Advantage, LLC, Parsippany, New Jersey
| | - Ann Marx
- Allergan plc, Irvine, California
| | - Sara Dill
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
25
|
Carruthers J, Donofrio L, Hardas B, Murphy DK, Jones D, Carruthers A, Sykes JM, Creutz L, Marx A, Dill S. Development and Validation of a Photonumeric Scale for Evaluation of Facial Fine Lines. Dermatol Surg 2016; 42 Suppl 1:S227-S234. [PMID: 27661745 PMCID: PMC5671789 DOI: 10.1097/dss.0000000000000847] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND A validated scale is needed for objective and reproducible comparisons of facial fine lines before and after treatment in practice and clinical studies. OBJECTIVE To describe the development and validation of the 5-point photonumeric Allergan Fine Lines Scale. METHODS The Allergan Fine Lines Scale was developed to include an assessment guide, verbal descriptors, morphed images, and real subject images for each scale grade. The clinical significance of a 1-point score difference was evaluated in a review of multiple image pairs representing varying differences in severity. Interrater and intrarater reliability was evaluated in a live subject validation study (N = 289) completed during 2 sessions occurring 3 weeks apart. RESULTS A score difference of ≥1 point was shown to reflect a clinically significant difference (mean [95% CI] absolute score difference, 1.06 [0.92-1.21] for clinically different image pairs and 0.50 [0.38-0.61] for not clinically different pairs). Intrarater agreement between the 2 live subject validation sessions was almost perfect (weighted kappa = 0.85). Interrater agreement was substantial during the second rating session (0.76, primary end point). CONCLUSION The Allergan Fine Lines Scale is a validated and reliable scale for physician rating of severity of superficial fine lines.
Collapse
Affiliation(s)
- Jean Carruthers
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lisa Donofrio
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
| | | | | | - Derek Jones
- Division of Dermatology, University of California, Los Angeles, Los Angeles, California
| | - Alastair Carruthers
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Lela Creutz
- Peloton Advantage, LLC, Parsippany, New Jersey
| | - Ann Marx
- Allergan plc, Irvine, California
| | | |
Collapse
|
26
|
Abstract
BACKGROUND A validated scale is needed for objective and reproducible comparisons of infraorbital hollows (i.e., tear troughs) before and after treatment in practice and clinical studies. OBJECTIVE To describe the development and validation of the 5-point photonumeric Allergan Infraorbital Hollows Scale. METHODS The scale was developed to include an assessment guide, verbal descriptors, morphed images, and real subject images for each grade. The clinical significance of a 1-point score difference was evaluated in a review of image pairs representing varying differences in severity. Interrater and intrarater reliability was evaluated in a live-subject validation study (N = 297) completed during 2 sessions occurring 3 weeks apart. RESULTS A score difference of ≥1 point was shown to reflect a clinically significant difference (mean [95% confidence interval] absolute score difference, 0.90 [0.79-1.02] for clinically different image pairs and 0.33 [0.19-0.46] for not clinically different pairs). Intrarater agreement between the 2 validation sessions was substantial (mean weighted kappa = 0.79). Interrater agreement was substantial during the second rating session (0.70, primary end point). CONCLUSION The Allergan Infraorbital Hollows Scale is a validated and reliable scale for physician rating severity of hollowing in the infraorbital area.
Collapse
|