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

BACKGROUND: Soft-tissue augmentation with injectable fillers is commonly performed in the malar area. A four-point scale, the Medicis Midface Volume Scale, was developed and validated as an objective measure of the severity of midface volume loss. METHODS: Using a separate photographic guide, four investigators rated photographs (front and right and left sides, to provide a full view of the face) of 60 untreated subjects in random order during two sessions 2 or more weeks apart. Both sides of the midface were scored separately as follows: 1, fairly full; 2, mild loss of fullness; 3, moderate loss, slight hollowing; and 4, substantial loss, clearly apparent hollowing. RESULTS: Most subjects (mean age, 45.7 years; range, 23 to 80 years) were women (72 percent) and white (87 percent). Intraobserver agreement between sessions was "almost perfect" (weighted kappa scores) for the right (0.918; 95 percent CI, 0.887 to 0.949) and left (0.911; 95 percent CI, 0.878 to 0.943) sides. Intraobserver exact agreement between sessions was 87.1 percent (range, 76.7 to 95.0 percent) for the right side and 86.3 percent (range, 76.7 to 95.0 percent) for the left. Interobserver agreement was "substantial" to "almost perfect" (weighted kappa scores) for the right (0.759 to 0.893) and left (0.758 to 0.888) sides. Interobserver exact agreement was 72.5 to 87.5 percent for the right side and 72.5 to 86.7 percent for the left. Overall, results were similar in nonwhite and white subjects. CONCLUSION: Consistent agreement by different evaluators and the same evaluator at different times validates the four-point Medicis Midface Volume Scale as suitable to objectively measure the severity of midface volume loss. CLINICAL QUESTION/LEVEL OF EVIDENCE: Diagnostic IV.