Validation of a 4-Point Photographic Scale for the Assessment of Midface Volume Loss and/or Contour Deficiency

Lorenc, Z. Paul

Goals/Purpose: Facial aging is associated with midface volume loss, which is commonly corrected with soft-tissue augmentation to restore fullness in the malar area. However, no validated scales exist for objectively rating the severity of midface volume and evaluating the efficacy of soft-tissue augmentation. This study was performed to validate a 4-point Medicis Midface Validation Scale (MMVS) developed to objectively measure the treatment efficacy of midface augmentation.

Methods/Technique: Four evaluating investigators were provided with the 4-point MMVS rating scale and a separate set of photographs exemplifying the scale. Using this photographic guide, the investigators rated photographs of 60 untreated subjects in random order on 2 clinic visits, which were separated by an interval of ≥2 weeks. The investigators evaluated 3 photos (front, right, and left sides) for each subject in order to have a full view of the face. Separate scores were recorded for the right and left sides of the midface using the following scale: 1 (fairly full midface), 2 (mild loss of fullness in midface area), 3 (moderate loss of fullness with slight hollowing below malar prominence), and 4 (substantial loss of fullness in the midface area, clearly apparent hollowing below malar prominence).

Results/Complications: The photographic subjects had a mean age of 45.7 years (range, 23–80 y); most were white (87%) and female (72%). There was “almost perfect” (i.e., weighted kappa scores 0.80–1.0) intraobserver agreement between sessions for the right (0.918; 95% CI, 0.887–0.949) and left (0.911; 95% CI, 0.878–0.943) sides of the midface. Intraobserver exact agreement between sessions was 87.1% (range, 76.7%–95.0%) for the right side of the midface and 86.3% (range, 76.7%–95.0%) for the left side. Interobserver agreement ranged from “substantial” to “almost perfect” (i.e., weighted kappa scores 0.60–0.79 and 0.80–1.0, respectively) for the right (0.759–0.893) and left (0.758–0.888) sides of the midface. Interobserver exact agreement was similar for the right (72.5%–87.5%) and left sides (72.5%–86.7%) of the midface. Overall, similar results were obtained in white and nonwhite subjects.

Conclusion: The high degree of intra- and interobserver agreement achieved, based on the interpretation of weighted kappa scores, indicates that the 4-point MMVS is a well-validated instrument that is suitable for clinical use to objectively grade response to midface volume augmentation.

Funding Source: This research was supported by Medicis Aesthetics Inc.