Development and Validation of a Photonumeric Scale for Evaluation of Jawline Contour

February 2023 | Volume 22 | Issue 2 | 203 | Copyright © February 2023


Published online January 27, 2023

doi:10.36849/JDD.7193Citation: Moradi A, Bloom JD, Verma A, et al. Development and validation of photonumeric scale for evaluation of jawline contour. J Drugs Dermatol. 2023;22(2):203-209. doi:10.36849/JDD.7193

Amir Moradi MDa, Jason D. Bloom MDb, Amit Verma DrPH MPHc, Nuo Cheng MSd, Ashlee W. Duncan MS PhDe

aPrivate Practice, Vista, CA
bPrivate Practice, Bryn Mawr, PA
cFormerly Global Clinical Development, Merz North America, Raleigh, NC (currently ABK Biomedical, Halifax, NS Canada)
dFormerly Clinical Reporting, Novella Clinical, Morrisville, NC (currently IQVIA Biotech, Morrisville, NC)
eGlobal Clinical Development, Merz North America, Raleigh, NC

Abstract
Background: A naturally aged face is often characterized by a noticeable lack of jawline contour and decreased volume in the lower region. Several options are available to redefine the jawline. To objectively evaluate treatment-related improvements in clinical practice and research, a validated photonumeric scale is needed.
Objective: To present scale-development methods for the Merz Jawline Assessment Scale and establish its reliability.
Methods: A 5-point photonumeric scale was developed to objectively assess jawline volume loss and contour disruption using male and female subjects of various ages and skin types. Seven board-certified dermatologists and plastic surgeons evaluated 90 subjects live in 2 sessions, 3 weeks apart to establish intra- and interrater reliability.
Results: The weighted kappa for intra- and interrater agreement were ≥ 0.7 in all cases. Intrarater agreement between the 2 rating sessions was nearly perfect (median weighted kappa = 0.908). Substantial interrater agreement between each rater pair was also demonstrated for both rating sessions.
Conclusion: The Merz Jawline Assessment Scale is a validated and reliable photonumeric scale for rating loss of jawline volume and contour. The scale maintains its validity and reliability with reproducible results across a diverse group of males and females of various ages and Fitzpatrick skin types.

J Drugs Dermatol. 2023;22(2):203-209. doi:10.36849/JDD.7193

Citation: Moradi A, Bloom JD, Verma A, et al. Development and validation of photonumeric scale for evaluation of jawline contour. J Drugs Dermatol. 2023;22(2):203-209. doi:10.36849/JDD.7193

INTRODUCTION

The aging face is often characterized by skin ptosis in the lower region and the loss of a defined mandibular margin.1 Multiple factors lead to this decreased level of jawline volume and/or its noticeable, undesirable contour, including loss of bone volume, atrophy, and the descent of fat.2 Volume loss in attachment points of the skin to the underlying superficial muscular aponeurotic system and/or to the bone results in specific patterns of deflation, pseudoptosis, and shadowing. Further, as soft-tissue fullness shifts from the upper face to the lower face, the aging face loses its youthful heart-shaped appearance and takes on a heavy, rectangular shape.3

Although a surgical facelift is the standard treatment used to address decreased volume levels or a noticeable and undesirable contour of the jawline, as the aesthetic market evolves, patients are increasingly seeking improved results with less invasive procedures and reduced downtime.4 Dermal fillers have been identified as a treatment option to straighten and re-establish volume and contour of the jawline. Fillers also provide an opportunity to enhance the size of the jaw by adding volume in the front at the chin and/or on the sides of the jaw. This enhancement can be achieved through filling volume and contour deficits, resulting in the enhancement of ptotic superficial compartments, repositioning of superficial fat, and/or tightening the skin around the jawline.4,5

Increased use of aesthetic facial fillers has driven the need for modern photonumeric scales to ensure objective and reproducible assessment of treatment response by demonstrating aesthetic improvement from baseline. Concurrently, regulatory agencies have pressed for more robust validation measures of new aesthetic scales, as well as establishing that these scales are fit-for-purpose in various clinical settings. Numerous facial-aging scales have been developed and validated over the past several years,6-18 and recent meta-analyses have compared over 100 such scales.19,20

The current work introduces the development and validation