Aesthetics.

Our everyday lives are full of aesthetic experiences. We wake up and frown at an overcast sky, or smile at the sight of the sun. Myriad decisions depend on the aesthetic appeal of the available options like which shirt to wear, which route to take to work, or where to eat. Even life-changing decisions, like where to live or who to live with, are partly based on their aesthetic appeal.

El perjuicio estético en el nuevo baremo / The aesthetic damage in the new scale

La valoración del daño o perjuicio estético a lo largo de los últimos 25 años ha ido evolucionando y existen unas reglas de utilización en la actual tabla VI del Real Decreto 8/2004 aceptadas por todos. Pero a diferencia del menoscabo psicofísico, el perjuicio estético continúa generando controversia, debido fundamentalmente a que es un daño que se puede objetivar, pero con un gran componente de «subjetividad» por parte tanto del lesionado como del perito. En la Ley 35/2015 de reforma del sistema de valoración se mantienen las reglas de utilización del perjuicio estético contenido en el Real Decreto 8/2004 y aparecen por primera vez una serie de factores a tener en cuenta en su valoración (visibilidad, atracción, reacción y alteración relación interpersonal), así como ejemplos de cada grado del perjuicio. La horquilla de puntos en cada grado se incrementa en función de la gravedad del daño, con la finalidad de poder avanzar en una mejor cualificación y cuantificación de este daño (AU)

The physical harm o aesthetic damage assessment in the last 25 years has progressed and there are some rules accepted by everybody for the use of the actual scale of Table VI contained in the Royal Decree 8/2004. Unlike the psychophysical impairment, the aesthetic damage continues to generate controversy because it can be objectified but with an important ‘subjective’ component, not only from the injured person but also from the expert in charge of the assessment. Law 35/2015 for the modification of the system for the assessment remains faithful to the use rules for the scale contained in the Royal Decree 8/2004, but for the first time it is introduced a series of factors which should be taken into account for the evaluation (visibility, attraction, reaction and interpersonal relationship alteration), as well as examples for each grade of injury, with the aim of developing a better qualification and quantification of this injury (AU)

Clinimetric properties and clinical utility in rehabilitation of postsurgical scar rating scales: a systematic review.

The aim of this study was to review and critically assess the most used and clinimetrically sound outcome measures currently available for postsurgical scar assessment in rehabilitation. We performed a systematic review of the Medline and Embase databases to June 2015. All published peer-reviewed studies referring to the development, validation, or clinical use of scales or questionnaires in patients with linear scars were screened. Of 922 articles initially identified in the literature search, 48 full-text articles were retrieved for assessment. Of these, 16 fulfilled the inclusion criteria for data collection. Data were collected pertaining to instrument item domains, validity, reliability, and Rasch analysis. The eight outcome measures identified were as follows: Vancouver Scar Scale, Dermatology Life Quality Index, Manchester Scar Scale, Patient and Observer Scar Assessment Scale, Bock Quality of Life (Bock QoL) questionnaire, Stony Brook Scar Evaluation Scale, Patient-Reported Impact of Scars Measure, and Patient Scar Assessment Questionnaire. Scales were examined for their clinimetric properties, and recommendations for their clinical or research use and selection were made. There is currently no absolute gold standard to be used in rehabilitation for the assessment of postsurgical scars, although the Patient and Observer Scar Assessment Scale and the Patient-Reported Impact of Scars Measure emerged as the most robust scales.

Abordaje intraoral de la glándula submaxilar. Presentación de un abordaje estético poco utilizado / Recurrent intraoral access to the submandibular gland. An uncommon aesthetic approach

Las alteraciones recurrentes de las glándulas submaxilares son unos trastornos relativamente frecuentes que se deben, generalmente, a una enfermedad obstructiva de la glándula, entre otras menos frecuentes, como la presencia de neoplasias, enfermedades autoinmunes o degenerativas. El tratamiento quirúrgico habitual consiste en la exéresis de la glándula submaxilar a través de un abordaje cervical. Las ventajas de este abordaje cervical son su sencillez, la visión directa del campo quirúrgico y la rapidez del procedimiento. Las desventajas más relevantes son la cicatriz cervical y la posibilidad de lesión de la rama marginal del nervio facial. Se presenta y discute el abordaje intraoral como acceso a la glándula submaxilar. Su ventaja respecto al abordaje convencional es la eliminación de la cicatriz cervical y el riesgo de lesión de la rama marginal. Sus desventajas fundamentales son la dificultad técnica, la visión reducida, el mayor tiempo quirúrgico empleado y la posibilidad de lesión del nervio lingual. En el Hospital Universitario de Canarias (Tenerife, España), a un total de 6 pacientes, 4 mujeres y 2 varones entre 25 y 60 años, se les realizó una submaxilectomía por abordaje intraoral. En todos los casos los resultados estéticos y funcionales fueron muy satisfactorios, tan solo leves disestesias del nervio lingual autolimitadas en 2 meses. Se presenta una alternativa por vía intraoral al abordaje cervical para la realización de submaxilectomía, con la ventaja principal de eliminar la cicatriz cervical (AU)

Recurrent sub-maxillary gland disorders are relatively common. They are mainly caused by obstructive gland diseases. Other aetiologies are malignancies, autoimmune, or degenerative diseases. The traditional treatment of the submandibular gland is the surgical excision by a cervical approach. The advantages of this approach are: its simplicity, direct surgical vision, and speed of the procedure. The most important disadvantages are: unsightly cervical scar, and injury risk of the marginal branch of the facial nerve. This paper presents and discusses the intraoral approach to the submandibular gland. The advantages over the conventional approach are: the elimination of the scar and the risk of injury to the marginal branch. The main disadvantages are: the technical difficulty, reduced vision, the longer surgical time, and the possibility of lingual nerve injury. A total of 6 patients, 4 women and 2 men aged 25 to 60 years, underwent a sub-maxillectomy by intraoral approach in the Hospital Universitario de Canarias (Tenerife, Spain). In all cases, the aesthetic and functional results were very satisfactory, with only mild self-limited lingual nerve dysesthesia being observed at two months. We present an alternative to the cervical approach for the submandibular glands; the intraoral approach. The major advantage of this technique is to eliminate the cervical scar (AU)

Objective measurements for grading the nasal esthetics on Basal view in individuals with secondary cleft nasal deformity.

OBJECTIVE: The purpose of this study is to ascertain objective nasal measurements from the basal view that are predictive of nasal esthetics in individuals with secondary cleft nasal deformity. DESIGN: Thirty-three patients who had undergone unilateral cleft lip repair were retrospectively reviewed in this study. The degree of nasal deformity was subjectively ranked by seven surgeons using standardized basal-view measurements. Nine physical objective parameters including angles and ratios were measured. Correlations and regressions between these objective and subjective measurements were then analyzed. RESULTS: There was high concordance in subjective measurements by different surgeons (Kendall's harmonious coefficient = W = .825, P = .006). The strongest predictive factors for nasal aesthetics were the ratio of length of nasal alar (r = .370, P = .034) and the degree of deviation of the columnar axis (r = .451, P = .008). The columellar angle had a more powerful effect in rating nasal esthetics. CONCLUSION: There was reliable concordance in subjective ranking of nasal esthetics by surgeons. Measurement of the columnar angle may serve as an independent, objective predictor of esthetics of the nose.

The aesthetic unit principle of facial aging.

IMPORTANCE: In youth, facial aesthetic units flow together without perceptible division. The face appears as a single dynamic structure with a smooth contour and very little if any shadowing between different anatomical regions. As one ages, facial aesthetic units slowly become distinct. This process may be a consequence of differences in skin thickness, composition of subcutaneous tissue, contour of the facial skeleton, and location of facial ligaments. Although the impact of aesthetic unit separation is clinically apparent, its fundamental role in perceived facial aging has not yet been defined empirically. OBJECTIVES: To evaluate and define the effect of aesthetic unit separation on facial aging and to empirically validate the rationale for the blending of aesthetic units as a principle for facial rejuvenation. DESIGN, SETTING, AND PARTICIPANTS: We prepared the photographs of 7 women for experimental evaluation of the presence or absence of facial aesthetic unit separation. Photographic stimuli were then presented to 24 naive observers in a blinded paired comparison. For each stimulus pair, observers were asked to select the facial photograph that they considered to be more youthful in appearance. Each stimulus was compared with all others. MAIN OUTCOMES AND MEASURES: We calculated a preference score for the total number of times any photograph was chosen to be more youthful compared with all others. Paired t tests were used to compare the preference scores between the facial stimuli with and without aesthetic unit separation. RESULTS: We generated 4032 responses for analysis. Photographs without facial aesthetic unit separation were consistently judged to be more youthful than their aged original or modified counterparts, with mean preference scores of 0.66 and 0.33, respectively (P ≤ .047). When we selected the paired stimulus that directly compared one photograph with aesthetic unit separation with another with blended aesthetic units (2015 pairs), observers indicated that the photograph with the blended aesthetic unit was younger 95% of the time. Within-rater reliability was found to be very good (r = 0.88). CONCLUSIONS AND RELEVANCE: Our data support the hypothesis that facial aesthetic unit separation influences perceived facial youthfulness among photographs of women. The presence of facial aesthetic unit separation results in a less youthful appearance. Based on these empirical data, the concept of facial aesthetic unit separation appears to play a significant role in perceived facial aging. LEVEL OF EVIDENCE: NA.

Use of scar and capsule flap for preventing the contour deformity after applying tissue expansion in patients with scar.

BACKGROUND: Tissue expansion is a reconstruction method often used to repair the tissue loss that results after removing soft tissue lesions such as scars, tumors, and giant hairy nevi. However, because the pressure of a tissue expander applies in all directions almost equally, along with the desired expansion of skin and subcutaneous fat tissue, the muscle and bone underneath the expander become depressed simultaneously. Even with a successful expansion of the tissue itself, the conventional surgical procedure results to frequent aesthetically dissatisfying outcomes because of contour irregularities. However, no studies have been conducted regarding the correction of these secondary deformities. METHODS: A surgical method to prevent secondary depression deformity was performed on a total of 80 patients who had undergone scar revision using tissue expansion between May 2002 and April 2012. First, the scar tissue was de-epithelized and transposed to fill the depressed area as a buried flap. Second, the capsule formed around a tissue expander was elevated as a flap and turned over to fill the depressed area. Lastly, the thickened capsule at the margins of the expander was used as a free capsule graft, which provides additional supports. Four plastic surgeons analyzed the postoperative aesthetic results after the surgery in an outpatient follow-up clinic. RESULTS: There were complications of tissue expansion in 7 patients: 5 had minor complications, which were successfully addressed with conservative treatments, and 2 had major complications, which required tissue expander removal during the course. In more than 85% of the patients, satisfactory postoperative aesthetic results were achieved without any perceivable depression or asymmetry. CONCLUSIONS: Secondary depression deformity induced by a tissue expander can be effectively prevented with a simple operative technique using capsule flaps, scar tissue flaps, and free capsule grafts.

The impact of geographic, ethnic, and demographic dynamics on the perception of beauty.

BACKGROUND: Beauty lies in the eyes of the beholder, but influenced by the individual's geographic, ethnic, and demographic background and characteristics. In plastic surgery, objective measurements are used as a foundation for aesthetic evaluations. This study assumes interdependence between variables such as country of residence, sex, age, occupation, and aesthetic perception. METHODS: Computerized images of a model's face were generated with the ability to alter nasal characteristics and the projection of the lips and chin. A survey containing these modifiable images was sent to more than 13,000 plastic surgeons and laypeople in 50 different countries, who were able to virtually create a face that they felt to be the aesthetically "ideal" and most pleasing. Demographic information about the interviewees was obtained. RESULTS: Values of various aesthetic parameters of the nose were described along with their relationship to geography, demography, and occupation of the respondents. Interregional and ethnic comparison revealed that variables of country of residence, ethnicity, occupation (general public vs surgeon), and sex correlate along a 3-way dimension with the ideal projection of the lips and the chin. Significant interaction effects were found between variables of country of residence or ethnicity with occupation and sex of the respondents. CONCLUSIONS: What are considered the "ideal" aesthetics of the face are highly dependent on the individual's cultural and ethnic background and cannot simply and solely be defined by numeric values and divine proportions. As confirmed with this study, ethnic, demographic, and occupational factors impact peoples' perception of beauty significantly.

Propuesta de un método para la valoración médico legal del perjuicio estético por cicatrices / A proposal for a method of forensic medical evaluation of the aesthetic damage of scarring

Una de las principales actividades en el ámbito médico forense es la valoración del perjuicio estético. Son diferentes los métodos recogidos en la literatura para efectuar esta valoración, pero sólo tres son dirigidos exclusivamente al daño estético ocasionado por cicatrices. Proponemos en este trabajo un método para la valoración médico legal del perjuicio estético por cicatrices: inicialmente se valoran y puntúan tres parámetros: zona del cuerpo donde está la cicatriz, longitud en centímetros y distancia a la que se ve la cicatriz. Cada uno de estos parámetros se pondera de forma diferente en la valoración global del perjuicio estético. El resultado podrá incrementarse o reducirse en función del grado de deformidad y del color de la cicatriz, aplicando una tabla cruzada. La puntuación final (sobre 100) se puede dividir por dos para asimilarla al RD Legislativo 8/2004 que contiene el baremo, actualmente vigente para la valoración de secuelas de un accidente de tráfico (AU)

One of the main activities in the medical forensic area is the evaluation of aesthetic damage. There are different methods reported in the literature to perform this evaluation, but only three are intended solely for the aesthetic damage caused by scarring. We propose, in this paper, a method for evaluation the damage forensic aesthetic scars: initially three parameters are evaluated and given a numerical value: the area of the body, the length in cm and distance at which the scar is seen. Each of these parameters is pondered differently in the overall evaluation of aesthetic damage. The result may be increased or decreased depending on the degree of deformity and scar color, applying a crossed table. The final result (out of 100) can be divided by two to assimilate the RDL 8/2004 containing the scale, currently applicable to the assessment of the consequences of an accident (AU)

Pterygium extended removal followed by extended conjunctival transplant: but on which eye?

PURPOSE: To assess the cosmetic result after pterygium extended removal followed by extended conjunctival transplant. METHODS: A web-based program was used by graders to select from a series of pairs of photographic images which eye of each pair had had pterygium surgery and which eye had the better appearance. A total of 395 pairs of eyes in which 1 eye had had pterygium surgery with the opposite eye acting as the control were assessed. Graders were asked the question "which eye has had surgery?" in sections 1 and 2, and then asked which "was the better looking eye?" for each pair, first at real-life size and then with magnified images in sections 3 and 4. Analysis was undertaken on the correlation of the selection of the eye that was thought to have had surgery with the eye that had actually had the surgery, and correlation between the eyes selected for the better appearance with the eyes that had had surgery. RESULTS: Thirteen graders completed the study and most graders correctly selected the operative eye in fewer than 50% of the pairs of eyes in sections 1 and 2. In addition, the operated eye was selected as the "better looking eye" in almost 40% of the pairs of eyes in sections 3 and 4. CONCLUSIONS: Pterygium extended removal followed by extended conjunctival transplant results in an appearance that is indistinguishable from a normal eye.

Voice attractiveness: influence of stimulus duration and type.

Voice attractiveness is a relatively new area of research. Some aspects of the methodology used in this domain deserve particular attention. Especially, the duration of voice samples is often neglected as a factor and happens to be manipulated without the perceptual consequences of these manipulations being known. Moreover, the type of voice stimulus varies from a single vowel to complex sentences. The aim of this experiment was to investigate the extent to which stimulus duration (nonmanipulated vs. normalized) and type (vowel vs. word) influence perceived voice attractiveness. Twenty-seven male and female raters made attractiveness judgments of 30 male and female voice samples. Voice samples included a single vowel /a/, a three-vowel series /i a o/, and the French word "bonjour" (i.e., "hello"). These samples were presented in three conditions: nonmanipulated, shortened, and lengthened duration. Duration manipulation was performed using the pitch synchronous overlap and add (PSOLA) algorithm implemented in Praat. Results for the effect of stimulus type showed that word length samples were more attractive to the opposite sex than vowels. Results for the effect of duration showed that the nonmanipulated sound sample duration was not predictive of perceived attractiveness. Duration manipulation, on the other hand, altered perceived attractiveness for the lengthening condition. In particular, there was a linear decrease in attractiveness as a function of modification percentage (especially for the word, as compared with the vowels). Recommendations for voice sample normalization with the PSOLA algorithm are thus to prefer shortening over lengthening and, if not possible, to limit the extent of duration manipulation-for example, by normalizing to the mean sample duration.

Estudo queiloscópico em graduandos de odontologia / A cheiloscopy study of undergraduate dental students

Objetivo: realizar um estudo queiloscópico pela análise de características dos lábios como método de identificação humana, observando-se as possíveis divergências entre padrões de expressões fenotípicas de sulcos labiais de acordo com o sexo do indivíduo. Metodologia: investigou-se o padrão labial de 104 graduandos do curso de Odontologia. Mensurou-se a espessura dos lábios na região de linha média, utilizando a Escala de Hyzer-Krauss, classificando-os em delgados, médios, grossos ou mistos, a fim de analisar a disposição das comissuras labiais foram realizadas duas fotografias por sujeito participante, categorizando-as em horizontais, abaixadas e elevadas. Para a classificação dos sulcos (Tipos: I - linhas verticais completas; I? - verticais incompletas; II - ramificadas; III ? entrecruzadas; IV - reticulares e V - padrões indefinidos), fez-se uso de batons individuais e a tomada de impressões em cartolina branca pelo movimento de ?rolagem? da esquerda para direita. Os dados foram analisados estatisticamente utilizando Testes Qui-quadrado de Pearson e Exato de Fisher (p=0,05). Resultados: as comissuras horizontais (58,7%) e os lábios mistos (64,4%) obtiveram maior percentual, com lábios inferiores tendendo a uma maior espessura. Quanto aos sulcos, o Tipo II apresentou-se mais frequente (25,5%) seguido pelos Tipos III (23,2%) e I (22,8%). Segundo a variável sexo, o Tipo III e IV obteve maior expressividade em homens, enquanto os sulcos II e I apresentaram-se prevalentes no sexo feminino (p menor que 0,001). Conclusão: o estudo das características labiais apresentou diferenças estatisticamente significantes no que condiz à análise dos padrões dos sulcos labiais, segundo o sexo do indivíduo, sendo sua análise relevante no método de identificação queiloscópica. As comissuras e a espessura labial não apresentaram tendências divergentes entre homens e mulheres.

Objective: To perform a cheiloscopy study by the analysis of lip characteristics as a method for human identification, observing the possible divergences among the phenotypical expression patterns of lip grooves, according to the gender. Method: The lip pattern of 104 undergraduate dental students was investigated. The lip thickness on the midline was measured, using the Hyzer-Krauss scale, which classifies the lips as thin, mean, thick or mixed. To analyze the lip commissure disposition, two photographs were taken of each participant, and classified as horizontal, downward and upward. For groove classification (Types: I - complete vertical lines; I? - incomplete vertical lines; II - branched lines; III - crossed lines; IV - reticular lines and V - undefined patterns) individual lipsticks were used and impressions were made on white carton paper with a ?roll? movement from left to right. Data were analyzed statistically by the Pearson?s chi square and Fisher?s exact tests (p=0.05). Results: The highest percentages were for horizontal commissures (58.7%) and mixed lips (64.4%) and the lower lips tended to be thicker. As for the grooves, Type II was the most frequent, followed by Types III (23.2%) and I (22.8%). For the gender variable, grooves types III and IV were more expressed among men, while types II and I prevailed among women (p less than 0.001). Conclusion: The study of lip characteristics revealed statistically significant differences relative to the analysis of lip grooves, according to the gender, and its analysis is relevant in cheiloscopy identification method. The lip commissures and lip thickness presented no divergent tendencies between men and women.

The virtual focus group: a modern methodology for facial attractiveness rating.

BACKGROUND: Traditional focus groups have been essential to facial aesthetics research. Although they are currently the criterion standard in acquiring facial attractiveness ratings, they retain many shortcomings. This study's objectives were twofold: to determine whether attractiveness scores obtained from a social network site correlate with those from the traditional focus group method; and to evaluate whether this methodology could be a superior tool in evaluating facial attractiveness. METHODS: Forty facial portraits were rated for attractiveness scores using three different subject recruitment methods: traditional live focus groups (n = 123 raters), Internet-based rating (n = 857 raters), and a novel method using a combination of focus groups and a social network site (i.e., Facebook) (n = 1775 raters). Each facial image was scored on a 10-point Likert scale. Regression analysis compared each approach to the traditional method. RESULTS: The methods varied in terms of data accrual time, rater demographics/ages, researcher's accessibility, necessity for subject incentives, researcher labor, and rater effort/accuracy. A strong correlation (0.922) existed between the online social network-based rating and focus group method. A minimum of 992 raters achieved stabilization of the attractiveness scores using social network-based rating. CONCLUSIONS: This study shows significant advantages to using a social network site-based method over both Internet-based rating and traditional focus groups for evaluating facial attractiveness. The main benefits include exponential increase in raters, minimized researcher time/labor, rater scores comparable to those of the focus group method, nonnecessity of rater monetary incentives, and selectable demographics/ages of raters.

Cosmesis after pterygium extended removal followed by extended conjunctival transplant as assessed by a new, web-based grading system.

OBJECTIVE: To design a web-based system to grade the cosmetic results after pterygium surgery and to use this to assess the aesthetic results of pterygium extended removal followed by extended conjunctival transplant. DESIGN: A standardized grading system with gradings of normal, excellent, good, fair, poor, and ungradeable was designed and tested by the author (standard gradings). This was then installed on a website where ophthalmologists and lay people could undertake grading and anatomy tutorials, and subsequently grade randomly assigned images in a masked fashion, of eyes after pterygium surgery and control eyes. PARTICIPANTS AND CONTROLS: A sample of 119 postoperative eyes were randomly selected from 279 consecutive surgeries together with 119 control eyes from the contralateral eyes of these patients supplemented with otherwise normal eyes. INTERVENTIONS: The author was tested twice on a sample of 40 images and then the full set, with 24 images repeated giving a total of 288 images using the proposed grading system, resulting in an intraobserver reliability score of 0.98. These images were then randomly presented to the graders, of whom 6 were postpterygium patients and 6 were corneal specialist ophthalmologists after they had completed the tutorials and passed a trial grading test. MAIN OUTCOME MEASURES: The percentage of images of postoperative and controls that were graded in each grading category were obtained and compared with the only existent study of post pterygium cosmetic results. RESULTS: Six lay people and 6 corneal specialists successfully passed the trial grading test of 40 images with weighted kappa of 0.70 to 0.85 and intraobserver reliability scores of 0.86 to 0.95 for lay graders and 0.90 to 0.92 for ophthalmic graders. Ninety-four percent of all pterygium surgery eyes were graded as acceptable; both ophthalmic and lay graders were unable to distinguish between postoperative and control eyes. CONCLUSIONS: This grading system is robust and user friendly, and pterygium extended removal followed by extended conjunctival transplant provides a very pleasing aesthetic result in most patients.

[Introduction to nursing aesthetics].

Empirical, aesthetic, ethical, and personal knowing are the four fundamental patterns of knowledge inquiry. Of these, the aesthetic knowing pattern is least discussed in nursing literature. This article discusses the definition of nursing aesthetics; its utilization in practice; and correlations between aesthetics and clinical practice. One of the advantages inherent to nursing is its ability to deliver skillful care directly to patients. Skillful performance is essential to reduce discrepancies between goals and patterns. Aesthetic nursing addresses more than the form of nursing. It further addresses the crucial elements of nursing knowledge. The science of nursing is influential in its ability to attain harmony among abundant empiric content, power of beneficence, and pleasure of aesthetic experience. In clinical practice, nurses can employ aesthetic nursing through various channels to create meaning and promote the professional image of nurses. Concepts listed in this article may be utilized in clinical supervision, practice and education.

Do increases in selected fitness parameters affect the aesthetic aspects of classical ballet performance?

Research has indicated that classical ballet dancers tend to have lower fitness levels and increased injury rates compared to other athletes with similar workloads. The aim of the current study was to examine the effects of a specifically tailored fitness training programme on the incidence of injury and the aesthetic quality of performance of classical ballet dancers compared to a control group. Proficiency in performance was evaluated at the beginning and end of the intervention period for both groups through a 4-min dance sequence using previously ratified marking criteria. The intervention group (n = 8) partook in a weekly 1-hr training session that included aerobic interval training, circuit training, and whole body vibration. All dancers' performance proficiency scores increased from pre-intervention testing to post-intervention. The intervention group's overall performance scores demonstrated a significantly greater increase (p = 0.03) than the equivalent for the control group. It was concluded that supplementary fitness training has a positive effect on aspects related to aesthetic dance performance as studied herein; further research is recommended on a larger and more varied sample. Practical applications from this study suggest that supplemental training should be part of a ballet dancer's regime, and minimal intervention time is required to have observable effects.

Development and validation of a photonumeric grading scale for assessing lip volume and thickness.

BACKGROUND: Currently, there is the need of a validated grading scale for assessing lip volume/thickness. OBJECTIVE: The aim of this study was to assist clinicians in managing individuals seeking lip rejuvenation and to provide an objective method for evaluating the efficacy and longevity of such treatments. METHODS: Using accepted criteria for the development of dermatological grading scales, we have developed and validated a photographic grading scale for assessing lip volume and thickness based on digital parallel-polarized light imaging. RESULTS: The photographic grading scale was shown to be a valid and reliable instrument for assessing lip volume and thickness, with good inter- and intra-grader consistency. The validity of the scale was demonstrated by its correlation with clinical evaluation and 3-dimensional measurements. CONCLUSIONS: This validated lip-volume/thickness grading scale should prove helpful in clinical trial settings to standardize clinical evaluations and to quantify results and measure the longevity of dermal fillers and other procedures for lip rejuvenation.