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Aesthetics Journal
Aesthetics
Group
Classification
Typical Age
Description
Skin Characteristics
I
Mild
28-35
No wrinkles
Early photoageing: mild pigment changes, no keratosis, minimal wrinkles, minimal or no makeup required
II
Moderate
35-50
Wrinkles in motion
Early to moderate photoageing: early brown spots visible, keratosis palpable but not visible, parallel smile lines begin to appear, wears some foundation
III
Advanced
50-65
Wrinkles at rest
Advanced photoageing: discolouration, visible capillaries, visible keratosis, wears heavier foundation
IV
Severe
60 and above
Only wrinkles
Severe photoageing: yellow/grey skin colour, prior skin malignancies, wrinkles throughout, no normal skin, cannot wear makeup because it cracks and cakes
Figure 2: The Glogau Classification10,14
Glogau scale or a modified Fitzpatrick scale) into consent form paperwork, alongside patient discussion notes, may also be of benefit to the practitioner. Limitations of WSRS A statistical review has pointed out an important drawback in which, subjectivity, especially during the use of WSRS in clinical studies, can vary quite dramatically.5 Interestingly, it uncovers that in a certain study, only 70% of the 30 photographed cases would be given the same wrinkle score when evaluating them on two separate occasions.5 It must be duly noted that the WSRS does not help us pick the most appropriate treatment for our patients (like botulinum toxin vs dermal filler) and is not useful in assessment of wrinkles/lines affecting other areas of the face other than the nasolabial folds. Alternate validated clinical scales such as the Glogau classification or modified Fitzpatrick wrinkle scales (which comprises three classes of nasolabial wrinkling) are more useful in these situations.11,12 With the rapidly progressive development of aesthetic techniques and a holistic, full face approach to treatment becoming more popular, the WSRS may now appear a little restricted in its clinical use. However, the nasolabial folds remain a common area of concern to our patients, therefore the WSRS is potentially still a useful clinical tool. The Glogau classification The Glogau classification, developed by dermatology professor Dr Richard Glogau in 1996, categorises wrinkle severity.10 Referenced by dermatologists, plastic surgeons and aesthetic practitioners worldwide, it is a reproducible and easy-to-use clinical scale that provides another useful measure of treatment effectivity.10 Those that fall under the category of wrinkles in motion, or dynamic lines, may have better outcomes with toxin injection, whereas deeper lines visible at rest or static wrinkles may be best treated with dermal filler. Skin characteristics here are also useful from a dermatology point of view when classifying and treating signs of photoageing. For further information, see Figure 2. Limitations of Glogau Alongside both patient and clinician subjectivity, the Glogau classification scale has limitations to other wrinkle rating scales. The main limitation is that it does not help select the specific procedures for each group or predict the response or anticipated skin reactions to topical treatments.13
Summary In conclusion, the WSRS provides a clinical tool for the objective assessment of nasolabial fold depth. Limitations include clinician subjectively and its use confined to that of dermal filler treatments addressing the nasolabial fold only. The Glogau classification helps to assess the face while in motion and is useful to classify and treat signs of photoageing. Although both are useful for facial assessment, using different validated tools together such as WSRS and the Glogau scale, along with before and after imagery in an aesthetics consultation, will provide both practitioner and patient with a reliable method of expectation and results management. Dr Rupert Critchley is the lead clinician and director of Viva Skin Clinics and its sister training faculty the VIVA Academy. After qualifying as a doctor in 2009, he has completed an array of courses in advanced nonsurgical aesthetics; attained MRCS part A and is also a fully qualified GP. REFERENCES 1. Shahrokh C. Bagheri, Chris Jo, Clinical Review of Oral and Maxillofacial Surgery, Elsevier Health Sciences, 2 Dec 2013. P414 2. Dr Amanda Oakley, Facial lines and wrinkles, Waikato Hospital, Hamilton, New Zealand, 2004. <https://www.dermnetnz.org/topics/facial-lines-and-wrinkles/> 3. Muhn C, Rosen N, Solish N, Bertucci V, Lupin M, Dansereau A, Weksberg F, Remington BK, Swift A, The evolving role of hyaluronic acid fillers for facial volume restoration and contouring: a Canadian overview. Clin Cosmet Investig Dermatol. 2012;5:147-58. doi: 10.2147/CCID.S30794. Epub 2012 Oct 5. 4. Clin Interv Aging. 2008 Dec; 3(4): 629–634.Published online 2008 Dec.PMCID: PMC2682392 Hyaluronic acid gel (Juvéderm) preparations in the treatment of facial wrinkles and folds 5. Day DJ1, Littler CM, Swift RW, Gottlieb S. The wrinkle severity rating scale: a validation study. Am J Clin Dermatol. 2004;5(1): 49-52. 6. Fagien S, Carruthers JD. A comprehensive review of patient- reported satisfaction with botulinum toxin type A for aesthetic procedures. Plast Reconstr Surg. 2008; 122:1915–25. 7. Carruthers, A., Carey, W., de Lorenzi, C., Remington, K., Schachter, D. and Sapra, S. Randomized, Double-Blind Comparison of the Efficacy of Two Hyaluronic Acid Derivatives, Restylane Perlane and Hylaform, in the Treatment of Nasolabial Folds. Dermatologic Surgery, 2005, 31: 1591–1598. 8. Nast, A., Reytan, N., Hartmann, V., Pathirana, D., Bachmann, F., Erdmann, R. And Rzany, B. Efficacy and Durability of Two Hyaluronic Acid–Based Fillers in the Correction of Nasolabial Folds: Results of a Prospective, Randomized, Double-Blind, Actively Controlled Clinical Pilot Study. Dermatologic Surgery, 2011. 37: 768–775. doi:10.1111/j.15249. Narins, R. S., Brandt, F. S., Dayan, S. H. And Hornfeldt, C. S. Persistence Of Nasolabial Fold Correction With A Hyaluronic Acid Dermal Filler With Retreatment: Results Of An 18-Month Extension Study. Dermatologic Surgery, 2011. 37: 644–650. 10. Glogau, R. G. Aesthetic and anatomic analysis of the aging skin. Semin. Cutan. Med. Surg. 15: 134, 1996. 11. Inja Bogdan Allemann and Leslie Baumann, Hyaluronic acid gel ( Juvéderm™) preparations in the treatment of facial wrinkles and folds’, Clin Interv Aging. 2008 Dec; 3(4): 629–634.<https://www.ncbi. nlm.nih.gov/pmc/articles/PMC2682392/> 12. David Shoshani, Md, Elana Markovitz, Rn, Stan J. Monstrey, Md, Phd,Y And David J. Narins, Md, Facsz, The Modified Fitzpatrick Wrinkle Scale: A Clinical Validated Measurement Tool for Nasolabial Wrinkle Severity Assessment, the American Society for Dermatologic Surgery, Inc, 2008. 13. Zein E. Obagi, The Art of Skin Health Restoration and Rejuvenation, Second Edition, CRC Press, 18 Dec 2014, p81 14. Richard G Glogau, Glogau Wrinkle Scale, http://sfderm.com/glogau-wrinkle-scale/>
Reproduced from Aesthetics | Volume 4/Issue 12 - November 2017