Sattler, Sonja

AbstractObjectiveQuantifying the degree of dorsal hand atrophy is a challenging endeavor, but often necessary, in both the clinical and the research setting. The aim of this investigation was to create and consecutively validate a 5‐point photonumeric scale for assessment of dorsal hand atrophy.Material and MethodsA medical team created a novel 5‐point photonumeric scale. Twelve international raters were involved in the digital validation, while five raters performed a live validation.ResultsFor the digital validation of the Croma Hand Atrophy Assessment Scale, a total of 72 subjects (58 females, 14 males) with a mean age of 43.0 ± 14.4 years [18–73 years] were assessed. For the live validation, 88 subjects (73 females, 15 males) with a mean age of 45.0 ± 14.1 years [20–73 years] were rated. The results revealed almost perfect intra‐rater (ICC: 0.90 [95% CI: 0.88–0.92]) and inter‐rater agreements (ICC: 0.85 [95% CI: 0.81–0.89] and 0.86 [95% CI:0.82–0.89]) in the digital validation and substantial intra‐rater (ICC: 0.79 [95% CI: 0.75–0.82]) and inter‐rater agreements (ICC: 0.75 [95% CI: 0.68–0.81] and ICC: 0.67 [95% CI: 0.54–0.77]) in the live validation.ConclusionThe created scale to assess dorsal hand atrophy has been shown to provide substantial‐to‐almost perfect agreement in the digital and live validation cycles and reached comparable intra‐rater and inter‐rater agreement to already published and validated scales. It is expected that the created scale will help physicians and researchers in the assessment of hand atrophy in the clinical and research setting in the future.

AbstractObjectiveThe 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 methodsTwo 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.ResultsFor 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.ConclusionThe 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.

AbstractObjectiveThe objective of this investigation was to create and validate 5‐point photonumeric scales for the assessment of dynamic crow's feet, static crow's feet, and infraorbital hollows.Material and methodsThree novel 5‐point photonumeric scales were created by a medical team. A total of 12 raters from all over the world performed a digital validation, and a total of 5 raters a live validation of the created scale.ResultsThe statistical analysis revealed almost perfect intra‐rater and inter‐rater reliability in the digital validation of the scales for the assessment of static and dynamic crow's feet as well as infraorbital hollows. In the live validation, both crow's feet scales showed almost perfect intra‐rater reliability, while the Croma Infraorbital Hollow Assessment Scale showed substantial intra‐rater reliability. Inter‐rater reliability was substantial for all three scales in the live validation. All three scales, the Croma Dynamic Crow's Feet Assessment Scale, Croma Static Crow's Feet Assessment Scale, and Croma Infraorbital Hollow Assessment Scale, were validated digitally and in a live setting.ConclusionThe created scales to assess infraorbital hollowing, dynamic and static crow's feet have been shown to provide substantial to almost perfect agreement in the digital and live validation and can thus be considered as helpful tools in the clinical and research setting. While technical methods and appliances to assess the degrees of severity of age‐dependent features are advancing, validated scales are of great importance due to their ease of use and, as shown by the validations, reliability, and reproducibility.

Background: Cosmetic treatment of the forehead using neuromodulators is challenging. To avoid adverse events, the underlying anatomy has to be understood and thoughtfully targeted. Clinical observations indicate that eyebrow ptosis can be avoided if neuromodulators are injected in the upper forehead, despite the frontalis muscle being the primary elevator. Methods: Twenty-seven healthy volunteers (11 men and 16 women) with a mean age of 37.5 ± 13.7 years (range, 22 to 73 years) and of diverse ethnicity (14 Caucasians, four African Americans, three Asians, and six of Middle Eastern descent) were enrolled. Skin displacement vector analyses were conducted on maximal frontalis muscle contraction to calculate magnitude and direction of forehead skin movement. Results: In 100 percent of investigated volunteers, a bidirectional movement of the forehead skin was observed: the skin of the lower forehead moved cranially, whereas the skin of the upper forehead moved caudally. Both movements converged at a horizontal forehead line termed the line of convergence, or C-line. The position of the C-line relative to the total height of the forehead was 60.9 ± 10.2 percent in men and 60.6 ± 9.6 percent in women (p = 0.941). Independent of sex, the C-line was located at the second horizontal forehead line when counting from superior to inferior (men, n = 2; women, n = 2). No difference across ethnicities was detected. Conclusions: The identification of the C-line may potentially guide practitioners toward more predictable outcomes for forehead neuromodulator injections. Injections above the C-line could mitigate the risk of neuromodulator-induced brow ptosis.