Facial Laxity Rating Scale Validation Study

BACKGROUND Age, weight change, clinical or surgical procedures, and distinctive characteristics, combine to be perceived as degrees of flaccidity. There is an absence of a validated scale to accurately assess the firmness-laxity spectrum of the face and neck with accepted classification and terminology. OBJECTIVE To create a simplified assessment tool to measure the degree of laxity in the face and neck: the Facial Laxity Rating (FLR) scale. METHODS The FLR scale evaluates 4 distinctive signs (eyelid folds, nasojugal folds, jowls, and neck profile) in 4 regions: upper face, middle face, lower face, and neck. This study incorporated a focused training component for 7 independent physician blinded photograph scorers. A total of 188 ratings were assessed. RESULTS Combined weighted kappa inter-rater agreement was 0.77 (95% CI, 0.76–0.78) for 188 ratings. Mean inter-rater agreement for laxity class was 0.78 (95% CI, 0.77–0.80). Agreement scoring relative to the truth standard was 92.53% (90.31–94.21), averaged for 7 investigators. CONCLUSION This study effectively presents the validation of the FLR scale for both inter-rater and agreement relative to the truth standard, demonstrating that the FLR scale may be used as a reliable instrument for quantitative assessment of chronological or treatment related laxity of the face and neck.