Downloaded from http://journals.lww.com/dermatologicsurgery by BhDMf5ePHKbH4TTImqenVOi5Xq/Qs+jz+yQRRHqyasG2ZRWX4co8PGRY3IAGo0Ya on 12/08/2019 Validation of a Photonumeric Assessment Scale for Grading the Slope of the Asian Forehead Yates Yen Yu Chao, MD,* Chiranjiv Chhabra, MD, † Niamh Corduff, MD, ‡ Sabrina Guillen Fabi, MD, x Carl S. Hornfeldt, PhD, ║ Martina Kerscher, MD, ¶ Stephanie Lam, MD, # Tatjana Pavicic, MD,** Peter H.L. Peng, MD, †† Rainer Pooth, MD, PhD, ‡‡ Berthold Rzany, MD, xx Kyle Seo, MD, PhD, ║║ Atchima Suwanchinda, MD, ¶¶ Fang-Wen Tseng, MD, ## and Thorin L. Geister, PhD ‡‡ BACKGROUND As the number of aesthetic treatments has grown, so have the number of photonumeric assessment scales used to compare the effectiveness of these aesthetic treatments in specific anatomical areas; however, these are primarily based on Caucasian features. OBJECTIVE To assess the validity of the first aesthetic scale for assessing the slope of the Asian forehead. A secondary objective was to correlate this scale with subject demographics and baseline characteristics. METHODS During 2 validation sessions, 13 raters assessed full frontal and lateral facial images of female (n = 28; 56.0%) and male (n = 22; 44%) subjects. For each subject, the severity of forehead sloping was graded from 0 (convex forehead, optimal forehead volume) to 4 (concave forehead, very severe sloping). Raters also assessed the age of each subject and the estimated aesthetic treatment effort required to treat each subject. RESULTS Inter-rater reliability was “substantial” with scores of 0.67 and 0.68 for the first and second vali- dation sessions, indicating high reliability. BMI showed the highest correlation with the scale and was a sig- nificant predictor in the final regression model. CONCLUSION This photonumeric assessment scale will be useful for assessing the slope of the Asian forehead in both clinical and research settings. Supported by Merz Pharmaceuticals GmbH, Frankfurt, Germany. The authors received an honorarium for participating in the consensus meeting. The authors have indicated no significant interest with commercial supporters. T he growing number of aesthetic treatments available for enhancing the appearance of aging skin has greatly increased their popularity. These include toxins, fillers, and numerous energy-based treatments. A growing number of photonumeric assessment scales have also been developed and validated by Merz Pharmaceuticals to compare the relative efficacy of different aesthetic treatments and techniques. These rating scales have been developed to objectively assess changes in age-related changes and treatment-related improvements in the upper face, 1 midface, 2 lower face, 3 global face, 4 platysma, 5 neck volume, 6 and d ´ ecollet´ e. 7 These scales are designed to be used alone to evaluate changes in specific *CHAO Institute of Aesthetic Medicine, Taipei, Taiwan; † Skin Alive, Delhi, India; ‡ Aesthetic Breast Surgery Centre, Corduff, Australia; x Goldman Butterwick Fitzpatrick Groff & Fabi, Cosmetic Laser Dermatology, San Diego, California; ║ Apothekon, Inc., Woodbury, Minnesota; ¶ University of Hamburg, Hamburg, Germany; # Central Health Medical Practice, Hong Kong, China; **Private Practice for Dermatology and Aesthetics, Munich, Germany; †† P-Skin Professional Clinic, Taipei, Taiwan; ‡‡ Merz Pharmaceuticals GmbH, Frankfurt, Germany; xx RZANY & HUND, Privatpraxis, Berlin, Germany; ║║ Department of Dermatology, Modelo Clinic, Seoul National University College of Medicine, Seoul, Korea; ¶¶ International Training Center in Laser Surgery, Ramathibodi University Hospital, Bankok, Thailand; ## Taoyuan Milano Aesthetic Clinic, Taipei, Taiwan © 2019 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved. ISSN: 1076-0512 · Dermatol Surg 2019;45:S38–S45 · DOI: 10.1097/DSS.0000000000001997 S38 © 2019 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.