METHODS: Two different novel five-point photonumeric scales for the assessment of static and dynamic forehead lines were developed. Moreover, a photoguide was created, including subjects from both sexes, all age groups, and different Fitzpatrick skin types. A total of 11 raters from all over the world were involved in the digital validation, whereas four raters performed a live validation.

RESULTS: The Croma Static Forehead Lines-Assessment Scale showed almost perfect inter and intra-rater agreement in both the digital and the live setting with inter-rater intraclass correlation coefficients of 0.86 [95% confidence interval (CI): 0.82-0.89] in the first digital rating and 0.82 [95% CI: 0.78-0.86] in the second digital rating. The Croma Dynamic Forehead Lines-Assessment Scale showed almost perfect inter and intra-rater agreement in the digital setting with inter-rater intraclass correlation coefficients of 0.83 [95% CI: 0.79-0.86] in the first digital rating and 0.80 [95% CI: 0.75-0.84] in the second rating and almost substantial agreement in the live setting.

OBJECTIVES: The objective of this investigation was to create and validate 5-point photo numeric scales which assess horizontal necklines, platysmal bands and wrinkles in the décolleté.

METHODS: A medical team created 3 different novel 5-point photonumeric scale for the assessment of horizontal necklines, platysmal bands and décolleté wrinkling. Eleven international raters were involved in the digital validation, while 4 raters performed a live validation.

RESULTS: The Croma Horizontal Neck Line - Assessment Scale showed substantial inter-rater agreement and almost perfect intra-rater agreement in the digital and live validations. The Croma Platysmal Bands-Assessment Scale showed substantial intra-rater agreement in both, digital and live validations. For the décolleté, a static and a dynamic scale was created and validated. The Croma Static Décolleté Wrinkling-Assessment Scale showed substantial and almost perfect inter-rater agreement in the digital validation and live-validation, respectively, while the intra-rater agreement was in both almost perfect. The Croma Dynamic Décolleté Wrinkling-Assessment Scale showed almost perfect agreement in both validation settings for both, inter-and intra-rater agreement.

OBJECTIVES: The objective of this investigation was to create and validate 5-point photo numeric scales which assess perioral lines and marionette lines.

METHODS: A medical team created two different novel 5-point photonumeric scale for the assessment of perioral lines and marionette lines. Eleven international raters were involved in the digital validation, while 4 raters performed a live validation.

RESULTS: For the Croma Static Perioral Lines-Assessment Scale digital inter-rater ICCs were 0.88 [95% CI: 0.85-0.91] in the first rating and 0.87 [0.83-0.90] in the second rating. The digital intra-rater ICCs were 0.90 [95% CI: 0.87-0.92]. In the live rating, the inter-rater ICCs were 0.89 [95% CI: 0.85-0.93] in the first rating and 0.91 [95% CI: 0.87-0.93] in the second rating with an intra-rater ICC of 0.91 [95% CI: 0.88-0.95]. For the Croma Marionette Lines-Assessment scale the digital rating inter-rater ICCs were 0.85 [95% CI: 0.81-0.89] in the first rating and 0.87 [95% CI: 0.84-0.90] in the second rating with an intra-rater ICC of 0.89 [95% CI: 0.88-0.91]. In the live rating, the inter-rater ICCs were 0.73 [95% CI: 0.54-0.83] in the first rating and 0.79 [95% CI: 0.65-0.87] in the second rating with an intra-rater ICC of 0.88 [95% CI: 0.83-0.94].

Methods: An international panel of experts in the field of aesthetic medicine convened to develop guidelines on effective and safe injection technique when performing treatments with the CPM-HA range of soft-tissue fillers.

Results: Consensus members considered treatment indications in the upper, middle and lower face. Landmark deficiencies and anatomical considerations are described for each indication and consensus recommendations provided on the optimal product, injection depth and treatment technique. This is supplemented by the experts advice on avoidance of complications. Throughout, an evidence-based approach to selection of products and injection techniques is provided. The result is a fully tailored approach to a range of indications covering the full portfolio of CPM-HA products, including the newest addition for skin revitalization.

Materials and Methods: A review of the literature was performed through databases such as PubMed using keywords including HA-fillers and complications, delayed HA filler sequelae and therapy, soft tissue and dermal filler reactions and management. Additionally, a survey comprised of questions regarding the management and treatment of DIRs was sent to 18 physicians highly experienced with soft-tissue filler injections in 10 countries. Their answers and recommendations were analyzed and debated amongst these panelists.

Results: Sixteen panelists favored antibiotic therapy as first-line treatment for DIRs, specifically dual antibiotic therapy consisting of a fluoroquinolone along with a tetracycline or macrolide for a period of 3-6 weeks. The majority refrained from the use of intralesional (IL) or systemic steroids except in the case of disfiguring or recalcitrant reactions. IL hyaluronidase was recommended by 13 panelists; however, some preferred a watchful waiting approach for a period of 48 hours to 2 weeks prior to IL hyaluronidase, and in cases where antibiotics did not lead to improvement.