Abstract
Background
Aging affects the face in all its dimensions. However, more has been published about the improvement of the periocular, midface, and perioral aging changes. We believe the profile view, particularly the preauricular area, is of great value when assessing the need for facial contouring procedures, as well as their effectiveness.
Objective
To develop and evaluate a classification based on the aging changes around the preauricular area, which aims to provide an objective direction to the appropriate treatment method.
Methods and Materials
All patients who attended the clinic for different aesthetic procedures between June 2019 and January 2020 were photographed. Two non-treating dermatologists and two non-treating plastic surgeons were asked to evaluate the perceived aging of the preauricular area using a three-point grading system. The assessment of each photograph was made once by each evaluator, and the inter-rater correlation was calculated.
Results
A total of 158 profile pictures of the preauricular area of 158 patients were evaluated by two non-treating dermatologists and two non-treating plastic surgeons. The inter-rater correlation was excellent at 0.942. The mean grading system of the patient samples was 1.42, with a standard deviation of 0.9 and a variance of 0.001.
Conclusions
The preauricular area is often overlooked and undertreated. Our results demonstrate an excellent inter-rater correlation between plastic surgeons and dermatologists at assessing the degree of aging in the area. This relatively hidden lateral area can serve as a test point, evaluating response to selected treatment before proceeding to full-face intervention. We suggest using a simple three-point scale to help guide treatment of the preauricular area and as part of our holistic approach to facial rejuvenation.
Level of Evidence IV
This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
Similar content being viewed by others
References
Pawlaczyk M et al (2013) Age-dependent biomechanical properties of the skin. Adv Dermatol Allergol. https://doi.org/10.5114/pdia.2013.38359
Rohrich RJ, Pessa JE (2007) The fat compartments of the face: anatomy and clinical implications for cosmetic surgery. Plast Reconstr Surg. https://doi.org/10.1097/01.prs.0000265403.66886.54
Pessa J (2009) The tear trough and lid/cheek junction: anatomy and implications for surgical correction. Plast Reconst Surg 123(4):1332–1340
Rohrich RJ, Pessa JE, Ristow B (2008) The youthful cheek and the deep medial fat compartment. Plast Reconstr Surg. https://doi.org/10.1097/PRS.0b013e31817123c6
Glogau RG (1996) Aesthetic and anatomic analysis of the aging skin. Semin Cutan Med Surg 15(3):134–138
Shoshani D, Markovitz E, Monstrey SJ, Narins DJ (2008) The modified fitzpatrick wrinkle scale: a clinically validated measurement tool for nasolabial wrinkle severity assessment. Dermatol Surg. https://doi.org/10.1097/00042728-200806001-00018
Day DJ, Littler CM, Swift RW, Gottlieb S (2004) The wrinkle severity rating scale: a validation study. Am J Clin Dermatol. https://doi.org/10.2165/00128071-200405010-00007
Leal Silva HG (2016) Facial laxity rating scale validation study. Dermatol Surg 42(12):1370–1379. https://doi.org/10.1097/DSS.0000000000000915
Lemperle G, Holmes RE, Cohen SR, Lemperle SM (2001) A classification of facial wrinkles. Plast Reconstr Surg 108(6):1735–1750. https://doi.org/10.1097/00006534-200111000-00048
Fitzpatrick RE, Goldman MP, Satur NM, Tope WD (1996) Pulsed carbon dioxide laser resurfacing of photo-aged facial skin. Arch Dermatol 132(4):395–402. https://doi.org/10.1001/archderm.1996.03890280047007
Carruthers A, Carruthers J, Hardas B, Kaur M et al (2008) A validated grading scale for forehead lines. Dermatol Surg. https://doi.org/10.1111/j.1524-4725.2008.34364.x
Hund T, Ascher B, Rzany B (2006) Reproducibility of two four-point clinical severity scores for lateral canthal lines (crow’s feet). Dermatol Surg. https://doi.org/10.1111/j.1524-4725.2006.32286.x
Pathak A, Mohan R, Rohrich R (2020) Chemical peels: role of chemical peels in facial rejuvenation today. Plast Recon Surg. https://doi.org/10.1097/PRS.0000000000006346
Motosko C, Khouri K, Poudrier G, Sinno S, Hazen A (2018) Evaluating platelet-rich therapy for facial aesthetics and alopecia: a critical review of the literature. Plast Recon Surg. https://doi.org/10.1097/PRS.0000000000004279
Leo MS, Kumar AS, Kirit R, Konathan R, Sivamani RK (2015) Systematic review of the use of platelet-rich plasma in aesthetic dermatology. J Cosmet Dermatol. https://doi.org/10.1111/jocd.12167
Britt CJ, Marcus B (2017) Energy-based facial rejuvenation: advances in diagnosis and treatment. JAMA Facial Plast Surg. https://doi.org/10.1001/jamafacial.2016.1435
Sadick N, Rothaus KO (2016) Aesthetic applications of radiofrequency devices. Clin Plast Surg. https://doi.org/10.1016/j.cps.2016.03.014
Beasley KL, Weiss RA (2014) Radiofrequency in cosmetic dermatology. Dermatol Clin. https://doi.org/10.1016/j.det.2013.09.010
Kinney BM, Andriessen A, DiBernardo BE, Bloom J, Branson DF, Gentile RD, Wu D (2017) Use of a controlled subdermal radio frequency thermistor for treating the aging neck: consensus recommendations. J Cosmet Laser Ther. https://doi.org/10.1080/14764172.2017.1343952
Locketz GD, Bloom JD (2019) Percutaneous radiofrequency lower face and neck tightening technique. JAMA Facial Plast Surg. https://doi.org/10.1001/jamafacial.2018.0917
Knight JM, Kautz G (2019) Sequential facial skin rejuvenation with intense pulsed light and nonablative fractionated laser resurfacing in fitzpatrick skin type II–IV patients: A prospective multicenter analysis. Lasers Surg Med. https://doi.org/10.1002/lsm.23007
Hall JA, Keller PJ, Keller GS (2004) Dose response of combination photorejuvenation using intense pulsed light-activated photodynamic therapy and radiofrequency energy. Arch Facial Plast Surg. https://doi.org/10.1001/archfaci.6.6.374
Fanous N, Zari S (2017) Universal trichloroacetic acid peel technique for light and dark skin. JAMA Facial Plast Surg. https://doi.org/10.1001/jamafacial.2016.1666
Robati RM, Asadi E (2017) Efficacy and safety of fractional CO2 laser versus fractional Er:YAG laser in the treatment of facial skin wrinkles. Lasers Med Sci. https://doi.org/10.1007/s10103-016-2111-8
Chen KH, Tam KW, Chen IF, Huang SK, Tzeng PC, Wang HJ (2017) Chen CC 2017 a systematic review of comparative studies of CO2 and erbium: YAG lasers in resurfacing facial rhytides. J Cosmet Laser Ther. https://doi.org/10.1080/14764172.2017.1288261
Shin MK, Lee JH, Lee SJ, Kim NI (2012) Platelet-rich plasma combined with fractional laser therapy for skin rejuvenation. Dermatol Surg. https://doi.org/10.1111/j.1524-4725.2011.02280.x
Alexiades-Armenakas M, Rosenberg D, Renton B, Dover J, Arndt K (2010) Blinded, randomized, quantitative grading comparison of minimally invasive, fractional radiofrequency and surgical face-lift to treat skin laxity. Arch Dermatol. https://doi.org/10.1001/archdermatol.2010.24
Funding
None
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflicts of interest to disclose.
Human or Animal Rights
This article does not contain any studies with human participants or animals performed by any of the authors.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Friedman, O., Artzi, O. & Haran, O. Preauricular Aging: A Three-Point Grading System to Guide Treatment in Facial Rejuvenation. Aesth Plast Surg 45, 2180–2187 (2021). https://doi.org/10.1007/s00266-021-02255-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00266-021-02255-x