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
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
