American Journal of Clinical Dermatology

, Volume 5, Issue 1, pp 49–52 | Cite as

The Wrinkle Severity Rating Scale

A Validation Study
  • Doris J. Day
  • Curt M. Littler
  • Richard W. Swift
  • Scott Gottlieb
Original Research Article


Background: Patient satisfaction is the most important outcome in facial aesthetic surgery. However, the need for evidence-based evaluation of aesthetic procedures dictates the use of more objective and quantitative measures of treatment outcome.

Objective: The present study was undertaken to validate a new clinical outcome instrument, the Wrinkle Severity Rating Scale.

Methods: Five clinical investigators were presented with 30 photographic images of the lower face and asked to rate nasolabial fold severity on each side using the 5-grade Wrinkle Severity Rating Scale (WSRS). Standardized definitions of the five grades were provided to the investigators in visual (photographic) and descriptive formats. To take into account possible facial asymmetry, nasolabial folds on the left and right sides of the face were rated separately. Assessments were conducted independently and were repeated after ≥2 weeks.

Results: Intra-observer (test-retest) agreement was 68.7% (left side) and 72.7% (right side); weighted kappa coefficients for the left and right sides were 0.77 and 0.81, respectively. Mean inter-observer agreement (internal consistency) was 67.7% (left side) and 72.3% (right side); weighted kappa coefficients for the left and right sides were 0.75 (95% CI 0.70–0.79) and 0.78 (95% CI 0.72–0.83), respectively.

Conclusion: The WSRS is a valid and reliable instrument for quantitative assessment of facial skin folds, with good inter- and intra-observer consistency. By allowing objective and reproducible grading of data, the WSRS should prove a useful clinical tool for assessing the effectiveness of soft-tissue augmentation and other facial contouring procedures.


Hyaluronic Acid Facial Feature Facial Asymmetry Nasolabial Fold Weighted Kappa Coefficient 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



This study was supported by Q-Med AB, Uppsala, Sweden. We thank Dr Andrew Frankel, MD (Division of Head and Neck Surgery, University of California at Los Angeles, CA, USA) for his contribution as an investigator in the study. The authors have no conflicts of interest that are directly relevant to the content of this manuscript.


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Copyright information

© Adis Data Information BV 2004

Authors and Affiliations

  • Doris J. Day
    • 1
  • Curt M. Littler
    • 2
  • Richard W. Swift
    • 3
  • Scott Gottlieb
    • 4
  1. 1.Department of DermatologyNew York University Medical CenterNew YorkUSA
  2. 2.SHARP Rees-Stealy Medical Group Inc.San DiegoUSA
  3. 3.Department of Plastic SurgeryManhattan Eye, Ear and Throat HospitalNew YorkUSA
  4. 4.Department of DermatologyHospital of the University of PennsylvaniaPhiladelphiaUSA

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