Aesth Plast Surg (2016) 40:556–565
DOI 10.1007/s00266-016-0640-y
REVIEW
Assessment Tools for Facial Rejuvenation Treatment: A Review
B. Hersant1 • R. Abbou1 • M. SidAhmed-Mezi1 • J. P. Meningaud1
Received: 2 December 2015 / Accepted: 15 April 2016 / Published online: 13 May 2016
Springer Science+Business Media New York and International Society of Aesthetic Plastic Surgery 2016
Abstract
Background In the field of cosmetic medicine, patient
satisfaction is an important and common indicator used to
measure the efficacy of the treatment. However, it is
insufficient to prove objectively that the benefit of the
specific factors involved in the cosmetic outcomes. The
practitioner should be aware of these assessment tools, in
particular in case of demanding or litigious patients.
Objective The aim of this review was to establish a list and
discuss the subjective and objective methods used to assess
facial aesthetic rejuvenation treatments.
Methods A systematic literature search was performed
using the Pubmed search engine. Studies published over
the last 5 years, i.e. between January 2010 and January
2015 were considered for review. The following keywords
were used: ‘‘aesthetic treatment’’, ‘‘facial rejuvenation’’,
and ‘‘subjective evaluation’’ or ‘‘objective evaluation’’.
Results Of the 446 articles identified by the search strategy,
47 articles focused specifically on facial rejuvenation and on
the efficacy of aesthetic medical treatments were retrieved for
review. Thirty-seven articles used quantitative methods to
assess aesthetic treatment outcomes and only 12 used sub-
jective methods. The different assessment methods were listed
according to the tools used and treatment indications.
Conclusion This review will help in choosing adequate
methods to assess facial rejuvenation medical treatment. It is
important to combine these tools adequately to improve the
assessment. There is no current consensus on assess
& B. Hersant
Barbara.hersant@gmail.com
1
Department of Maxillofacial and Plastic & Reconstructive
Surgery, Henri Mondor Hospital, 51 avenue du Mare´chal de
Lattre de Tassigny, Cre´teil 94010, France
123
NON-SURGICAL AESTHETIC
facial rejuvenation treatments but we noted that objective
assessment methods seem helpful.
No Level Assigned 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.
Keywords Aesthetic treatment Facial rejuvenation
Subjective evaluation Objective evaluation
Introduction
The practice of cosmetic medicine, in particular facial
rejuvenation, has increased dramatically over the last
decade. The goal of these cosmetic treatments is to obtain
an obvious and visible result. Patients are increasingly
demanding and need to be convinced by the before/after
treatment difference. In the field of cosmetic medicine,
patient satisfaction is an important and common indicator
used to measure the efficacy of the treatment. However, it
is insufficient to prove objectively the benefit of the
specific factors involved in the cosmetic outcome. Pictures
are indispensable items and remain the most useful tool to
show the before/after treatment difference. However, other
tools may be used to assess the efficacy of facial rejuve-
nation treatments. Objective methods with non-invasive
instruments have been increasingly used over the last 2
years to assess cutaneous changes. They provide quan-
titative data about the efficacy and safety of the treatments.
The practitioner should be aware of these assessment tools,
in particular in case of demanding or litigious patients.
Moreover, research in aesthetic medicine has also dra-
matically progressed over the last 10 years. Assessment
Aesth Plast Surg (2016) 40:556–565
tools are necessary to highlight a significant difference in
terms of endpoint and to publish scientific papers in the
field of facial rejuvenation.
In this context, we conducted a literature review of these
assessment tools.
The aim of this review was to establish a list and discuss
the subjective and objective methods used to assess facial
aesthetic rejuvenation treatments. The most relevant pub-
lications associated with the mentioned topics are pre-
sented and analysed.
Materials and Methods
A systematic literature search was performed using the
Pubmed search engine. Studies published over the last 5
years, i.e. between January 2010 and January 2015 were
considered for review. The following keywords were used:
‘‘aesthetic treatment’’, ‘‘facial rejuvenation’’, and ‘‘subjec-
tive evaluation’’ or ‘‘objective evaluation’’, either as MeSH
(medical subject headings) terms or free text displayed in its
entirety only in the title or abstract. A manual search of the
references of clinical trial reports was performed to identify
additional relevant studies. Inclusion criteria were
comparative studies conducted in humans with a sample size
of at least 10 subjects. No restrictions were applied to patient
characteristics. Animal studies, in vitro studies, studies
assessing aesthetic surgical treatment and studies published in
any language other than English and French were excluded.
One operator screened titles and abstracts related to facial
rejuvenation using aesthetic medical treatment for potential
eligibility. The data from full texts were extracted using a
standardized data collection form to record the assessment
method, the corresponding number of references found,
author conclusions and its validity.
Results
A flow chart of the selected studies is presented in Fig. 1.
A total of 446 articles were identified by the search
strategy, of which 47 articles focused specifically on facial
rejuve-nation and on the efficacy of aesthetic medical
treatments were retrieved for review. Among them, 12
articles were based on subjective scale assessment
methods, 24 both on objective and subjective assessment
methods and 11 only on objective assessment methods.
Subjective Methods To Assess Facial Rejuvenation
Treatment
Twenty-four articles have reported skin rejuvenation
assessed using subjective and objective methods and 12
557
studies using only subjective methods (Table 1). These
subjective methods included the wrinkle severity rating
scale (WSRS), the global aesthetic score (GAIS) and the
medicis midface volume scale (MMFVS).
Wrinkle Severity Rating Scale (WSRS)
It is a validated 5-point scale, whose score varies from 1,
indicating a minimum wrinkle severity to 5, indicating a
maximum severity, with 1 = absent, 2 = mild, 3 = mod-
erate, 4 = severe, and 5 = extreme. This scale is based on
the current aspect rather than on a comparison with the
pretreatment aspect provided in visual (photographic) for-
mat. It has initially been specifically designed for mea-
suring nasolabial folds. The fold severity scoring is based
on the visual assessment of the length and apparent depth
of the nasolabial fold, without reference to the baseline or
pretreatment aspect.
The WSRS has been used in 12 articles to assess facial
wrinkles, nasolabial folds and skin rejuvenation. Among
these articles, 8 articles used the WSRS to assess the
efficacy of different hyaluronic acid formulations on the
correction of nasolabial folds (Table 1). To assess wrinkle
severity, Calabaro et al. [9] have investigated the WSRS
which was used by blinded investigators and reported that
this scale is a valid quantitative assessment with good
intra- and interobserver agreement. Further-more, Choi and
collaborators, using only subjective methods, have shown
that it is important to validate the treatment assessment by
developing objective methods [4]. Oee et al. have used a
subjective assessment based on photographs and an 8-
grade wrinkle scoring, but they have not specified if the
evaluators were blinded or not. The authors have
concluded that, in addition to subjec-tive assessment
methods, a quantitative analysis is rec-ommended using
more objective methods to minimize the interrater
variability [20]. In a recent study, Shin et al. [2] and Asher
et al. [6] reported subjective assessment by blinded
investigators of the efficacy of a dextran filler and different
forms of hyaluronic acid on the correction of nasolabial
folds. Finally, Brandt and collaborators have used the
WSRS to assess facial wrinkles treated with hyaluronic
acid but they have not specified if the evaluators were
blinded [5].
Global Aesthetic Improvement Scale (GAIS)
The GAIS is a 5-grade subjective test used to analyse the
efficacy of the treatment. The score varies from 1, indi-
cating a strong improvement to 5, indicating a worse out-
come. The physician and the patient independently assess
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Fig. 1 Flow chart of the reviewed studies
the improvement compared to the baseline aspect at each
post-treatment timepoint.
Four articles used both the WSRS and the GAIS to
assess the clinical efficacy of intradermal injection of
hyaluronic acid on the correction of nasolabial folds (Table
1) [3, 4, 7, 8, 15]. The GAIS has also been used to assess
the efficacy of platelet-rich fibrin matrix (PRFM) on the
correction of deep nasolabial folds [8]. Furthermore, Lee et
al. [14] have reported a before/after comparison performed
by two dermatologists using the GAIS to assess the
efficacy of the treatment with polymethylmethacrylate
cross-linked dextran (PMMA) and hydroxypropyl methyl-
cellulose (HPMC) on nasolabial folds.
One study has only used photographs to assess the
efficacy and safety of L-polylactic acid on the management
of facial ageing [24].
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Medicis MidFace Volume Scale (MMVS)
It is a highly accurate and valid 4-point scale used for assessing
the midface volume loss using a photographic guide. The MMVS
has been developed and validated as an objective measurement of
the midface volume loss severity [25].
In his study, Bertucci et al. used the MMVS scale to assess
the efficacy of large gel particle hyaluronic acid with 0.3 %
lidocaine in the correction of midface volume loss [16].
Face Visual Scale
The face visual scale is a subjective instrument measuring
patient satisfaction. Six selected studies have shown a
significant mean improvement based on a 0–10 scale in
Aesth Plast Surg (2016) 40:556–565 559

Table 1 Subjective methods of evaluation of cosmetic and aesthetic treatment

Subjective methods References Indication Evaluated treatment
of evaluation

WSRS 12 articles [1–12] Treatment and correction of nasolabial Different formulations of hyaluronic
folds, facial wrinkle and fold around acid, platelet-rich fibrin matrix,
mouth, skin rejuvenation Nifedipine, dextran filler and
mesotherapy
GAIS 12 articles [3– 5, 7, 8, 12– Treatment and correction of nasolabial Different formulations of hyaluronic
18] folds, facial wrinkle, skin rejuvenation, acid, polymethylmethacrylate
periorbital rejuvenation, bilateral cross-linked dextran (PMMA),
volume loss of the cheeks and midface hydroxypropyl methylcellulose
volume loss (HPMC) platelet-rich fibrin matrix,
mesotherapy
Medicis midface One article [16] Midface volume loss Hyaluronic acid with 0.3 % lidocaine
volume scale
(MMVS)
Face visual scale Six articles [10, 19–23] Facial wrinkle Validation of facial wrinkle using 3D
Nasolabial folds, fringe projection
Wrinkles Different formulations of hyaluronic
acid
wrinkles
Wrinkles Fractional erbium YAG, intense-
pulsed light therapy, CD-atRA
Photo-ageing
Multimodal fractional ablative
treatment
Hyaluronic acid
Intense-pulsed light therapy

patients receiving skin treatment such as hyaluronic acid,
fractional YAG laser and intense-pulsed light treatment
[10, 19–23].
In all these studies, no objective assessments have been
used to obtain accurate data and conclusions.
Objective Methods To Assess Facial Rejuvenation
Treatment
Thirty-eight studies using objective assessment methods have
been reviewed (Table 2). Among them, 24 articles used both
subjective and objective assessment methods. The different
subjective methods used included pho-tographs, patient
satisfaction or/and physician global assessment, the WSRS,
the GAIS and a visual analogue scale (VAS). For example in
the study by Calabaro et al. [9], the WSRS was combined
with the use of a cor-neometer, tewameter and cutometer to
assess facial wrinkle improvement after topical application of
nifedipine. Overall, the WSRS is used to assess the efficacy of
dif-ferent hyaluronic acid formulations on nasolabial folds in
combination with 3D imaging or reflectance confocal
microscopy (RCM) [10, 11]. Moreover, the GAIS is
combined with a histological analysis to test the efficacy of
mesotherapy on skin rejuvenation [12] and with midface
volume scale score for the treatment of midface volume loss
by large gel hyaluronic acid.
Regarding objective assessments, the authors have used
various types of quantitative methods combined with
invasive or non-invasive methods to quantify improve-
ments in variable skin changes such as wrinkles, hyper-
pigmentation, pore size and other aesthetic features.
Among the various objective methods used, we noted:
Histological Evaluation
Nine studies of the 34 reviewed articles were based on a
histological evaluation, a highly accurate and valid
microscopic analysis of the skin chemical and cellular
properties [12, 22, 26–28]. Among them, three studies
have assessed the efficacy of mesotherapy, YAG laser and
radiofrequency on skin rejuvenation. Two studies have
investigated the periorbital wrinkle improvement after
mesotherapy [26] and YAG laser therapy [31].
Using a histological analysis, El-Domyati et al. [45] assess
the efficacy of mesotherapy on histological changes such as
changes in the concentration of newly synthesized collagen
types I, III and VII and elastin compared to baseline. Other-
wise, to assess the response of multiple fractional erbium laser
sessions for skin rejuvenation, quantitative evaluations by
histochemistry and immunochemistry of collagen types I, III
and VII, newly synthesized collagen, total elastin and
tropoelastin were performed [31]. Moreover, the assessment

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Table 2 Objective methods of evaluation of cosmetic and aesthetic treatment

Objective methods of References Indications Evaluated treatments
evaluation

Histological analysis 9 articles [11, 12, 22, 26–32] Periorbital wrinkle Mesotherapy
Nasolabial folds Hyaluronic acid with 0.3 % lidocaine
Skin rejuvenation Mesotherapy
Photoaged skin Bipolar Radiofrequency
Wrinkles Hyaluronic acid
Photodamaged skin Fractional CO(2) laser
Skin rejuvenation Radiofrequency MPCRF
Periorbital rhytides YAG laser
Photo-ageing Intense-pulsed light
Cutometer 8 articles [9, 15, 20, 23, 27, 33– Facial wrinkle Different formulations of hyaluronic acid
35] Facial wrinkles Nifedipine
Wrinkles Low molecular hyaluronic acid
Wrinkles Fractional erbium YAG, intense-pulsed light
Photoaged skin therapy, CD-atRA
Photo-ageing Bipolar radiofrequency
Melsma Intense-pulsed light treatment
YAG laser
3D imaging 5 articles [10, 17, 18, 21, 36] Nasolabial folds Different formulations of hyaluronic acid
Wrinkle Multimodal fractional ablative treatment
Periorbital rejuvenation Hyaluronic acid
Bilateral volume loss of the Hyaluronic acid
cheeks Fractional CO2 laser
Photodamaged facial skin
3D fringe projection One article [19] Facial wrinkle Validation of facial wrinkle using 3D fringe
projection
Dermoscopy One article [37] Face and neck rejuvenation Platelet-rich plasma
Reflectance confocal One article [11] Nasolabial folds Hyaluronic acid with lidocaine
microscopy (RCM)
Corneometer Seven articles [9, 15, 23, 33–35, Facial wrinkles Different formulations of hyaluronic acid
38] Facial wrinkles Nifedipine
Periorbital dark circles and Platelet-rich plasma
crow’s feet Hyaluronic acid
Facial wrinkles Intense-pulsed light treatment
Photoageing Niosomes entrapped with the rise bran
Anti-ageing YAG laser
Melasma
Chromatometer Four articles [9, 33, 36, 39] Facial wrinkles Nifedipine
Facial wrinkles Low molecular of hyaluronic acid
Photo-ageing Intense-pulsed light treatment
Melasma YAG laser
Visometer Four articles [23, 40–42] Facial wrinkles Secretory factors of endothelial precursors
Anti-wrinkle cells (hESC-EPC)
Photoageing Green tea
Rejuvenation of Intense-pulsed light treatments
photodamaged skin YAG laser

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Table 2 continued
Objective methods of References Indications Evaluated treatments
evaluation

Mexameter Six articles [29, 34–36, 38, 40] Facial wrinkles Secretory factors of endothelial precursors
Periorbital dark circles and cells (hESC-EPC)
crows’ feet platelet-rich plasma
Photo-ageing Intense-pulsed light treatments
Rejuvenation of YAG laser
photodamaged skin Niosomes entrapped with the rise bran, Laser
Anti-ageing YAG
Melasma
Sebumeter Six articles [13, 23, 29, 42– 44] Acne Fractional radiofrequency microneedle
Oily skin Botulinum Toxi A
Photoageing Intense-pulsed light treatment
Rejuvenation of YAG laser
photodamaged skin Botulinum Toxi A
Forehead rhytides Long-pulsed and YAG laser
Treatment of enlarged pores
Tewameter One article [9] Facial wrinkles Nifedipine
Visioscan Two articles [3, 35] Facial wrinkles Green tea and lotus extract
Melasma Niosomes entrapped with the rise bran, Laser
YAG

of the effect of bipolar radiofrequency on photoaged skin
in Asian subjects was carried out on the quantification of
the level of procollagen types I and III and elastin [27].
Further-more, after photorejuvenation with fractional CO2
laser, Prignano et al. [28] assessed skin changes using
histological ultrastructure analysis.
The 3D colour schematic representation compares the
volumes measured on photographs before and after the
treatment. This method is very accurate. Five studies have
shown the benefit of using this method to assess the effi-
cacy of skin ageing treatment on volume loss of periorbital
rejuvenation [17] or cheeks [18] or on photodamaged
facial skin [10, 21, 36].

Cutometer
This highly accurate and valid device measures the defor-
mation of a skin area subjected to a mechanical stress
induced by a non-invasive suction and its power recovery.
Cutometers such as the dermalab measure skin elasticity
and other biomechanical parameters. Twenty-four percent
of reviewed articles have used a cutometer to assess skin
elasticity and facial wrinkle improvement. Ooe et al., Kim
et al. Jegasothy et al. and Shin et al. [9, 15, 20, 23, 27, 33–
35] assess the skin elasticity after the use of wrinkle
treatment methods as well as hyaluronic acid, fractional
erbium:YAG laser treatment, intense-pulsed light therapy
and bipolar radiofrequency.
3D Imaging Analysis
3D imaging is a quantitative volume measurement tool
assessing the postoperative amount of volume change
using a camera and software.
3D Fringe Projection
This 3D projection method is used to rapidly, accurately and
directly assess skin topography. It is based on the digital
projection of a striped pattern in a defined angle onto the skin
in vivo. When analysing the striped pattern distortions, it is
possible to reconstruct the 3D structure of the skin.
Luebberding et al. [19] have reported the benefit of the
use of a 3D fringe projection in facial wrinkle assessments.
Dermoscopy
The dermascope is used to examine the skin, it consists of
a high-magnification polarizing lens and multiple ultra-
bright light emitting diodes (LEDs) commonly used by
dermatologists.
One article based on dermoscopy was identified. Redaelli
et al. [37] used a dermascope to assess the efficacy

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of platelet-rich plasma on face and neck revitalization, in
skin rejuvenation and in scar reduction.
Reflectance Confocal Microscopy (RCM)
Reflectance confocal microscopy (RCM) is a non-invasive
imaging modality of the epidermis and superficial dermis.
Compared to dermoscopy, RCM acquires very accurately
images with an excellent cellular resolution. Royo de la
Torre et al. [11] have compared the clinical efficacy of two
types of filler on the correction of the nasolabial fold in
119 patients and assessed it using RCM. They have shown
changes in dermoepidermal junction after treatments.
Corneometer
The corneometer is used to determine the stratum corneum
hydration. Seven studies (19 % of reviewed studies using
quantitative methods) used a corneometer to assess the
efficacy of an anti-wrinkle treatment, photoageing and
periorbital dark circles on skin hydration [9, 23, 33].
Mehryan et al. [38] measured stratum corneum hydration
after platelet-rich plasma injections.
Chromatometer or Spectrocolorimeter
The chromatometer is used to determine or specify colours
relative to spectroscopic or visual standards. It may also be
used to determine skin change brightness. Four studies
have used a chromatometer to assess facial wrinkle
improvement, photoageing and melasma. This method is
accurate. Shin et al. [23] have used this device to assess the
improvement of the facial pigmented aspect of the skin in
Korean patients after intense-pulsed light sessions. To
measure erythema, Jegasothy et al. [33] have used a
chromatometer in the periorbital regions after topical
application of nano hyaluronic acid. Furthermore, Calabro
et al. [9] have used the same device to assess the skin
lightening during application of nifedipine.
Visiometer
The visiometer is a tool used to assess the topography
(microrelief) of the skin: it measures skin roughness and
furrow depth using light transmission through a very thin
skin replica. To investigate the anti-ageing effect of
microneedling plus secretory factors of human embryonic
stem cell-derived endothelial precursor cell (hESC-EPC)
treatment, Lee et al. [40] have used the visiometer to
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Aesth Plast Surg (2016) 40:556–565
measure skin roughness. Koh et al. [29] have assessed skin
roughness and texture after photodamaged skin rejuvena-
tion with YAG laser. Furthermore, a treatment with
tennase has been assessed with the visiometer on wrinkles
improvement [41].
Mexameter
The mexameter is used to quantitatively assess colour
changes after treatments. This instrument uses arrays of
LEDs that emit light at three defined wavelengths: 568
(green), 660 (red) and 880 nm (infrared). Six reviewed
studies used a mexameter. Mahryan et al. [38] assessed the
change in the melanin index after treatment of periorbital
dark circles by platelet-rich plasma injections. The study
by Lee et al. [40] showed a significant decrease in melanin
index at the site treated with microneedling plus hESC-
EPC. Moreover, analysis using the mexameter has revealed
changes in pigmentation after laser treatment of photo-
damaged skin [36].
Sebumeter
The sebumeter is used to determine the amount of sebum
secretion. It measures the variation in light transmission
through the strip, which is proportional to the amount of
lipids absorbed. To assess the efficacy of YAG laser on
photodamaged skin rejuvenation, Koh et al. [29] used a
sebumeter to determine the amount of secreted sebum. Lee
et al. [13] reported changes in sebum secretion and sebum
levels after treatment with fractional radiofrequency on
acne. Otherwise, the sebum production in the forehead
region was quantified by sebumeter after treatment of oily
skin with botulinum Toxi A [43].
Tewameter
The tewameter is used to determine the transepidermal
water content. One article has been identified in the liter-
ature search, showing changes in skin condition after
topical application of 0.5 % nifedipine [9].
Visioscan
The visioscan is used to measure the surface of the living
skin, based on the evaluation of an image of living skin
taken under illumination to determine its roughness,
wrinkling, scaliness and smoothness. The use of this
method has been identified in two studies [35, 46].
Aesth Plast Surg (2016) 40:556–565
Discussion
Assessing the efficacy of facial rejuvenation treatments is a
relatively new field of research. Indeed, 90 % of papers on
this topic have been published over the last 10 years.
Although the number of high-quality publications assessing
facial rejuvenation treatments in clinical practice remains
limited, the number of studies assessing their efficacy when
combined with paraclinical and objective assessments has
increased over the last 2 years. This review allowed us to
significantly reduce the scope of research as, to our knowl-
edge, no other review has been published on this topic.
This review was designed to investigate reliable meth-
ods to assess the efficacy of facial rejuvenation treatment.
We focused our literature search on the last 5 years. The
peak incidence of publication was in 2014 (Fig. 2). Most of
the studies using both subjective and objective assessment
methods were published in 2013 and 2014, and their
number was doubled compared to the previous 3 years.
Two scales appeared essential for subjectively assessing
the efficacy of cosmetic treatment for skin rejuvenation.
The first scale is the WSRS which is used to assess wrinkle
severity, and the second one is the GAIS which is used to
assess treatment outcomes. To minimize bias, the WSRS
should be used by blinded investigators, and for the GAIS,
independent evaluators are needed. In all studies using the
WSRS, the authors have not specified if the investigators
were blinded. Calabaro et al. reported that the WSRS is a
valid instrument with a good intra- and interobserver
agreement, but no statistical analysis has been used in this
study. Furthermore, the use of a scale or questionnaire to
assess patient satisfaction is very important to determine
patient aspect and satisfaction degree; patient satisfaction
appears as an essential item but these subjective clinical
assessments lack the precision of the quantitative methods
[12, 21, 22, 26, 28, 42, 44, 46, 47].
One study using only photographs to assess the efficacy
of L-polylactic acid on skin ageing has been identified in
Fig. 2 Assessment methods used for cosmetic and aesthetic treat-
ment outcomes over the last 5 years (2010–2015)
563
this review but it is not reported in tables because it pre-
sented very poor results in terms of wrinkle improvement
[24]. Moreover, when using photographs, it is critical that
the before and after pictures be standardized.
Regarding objective methods, the histological exami-
nation is the gold standard [11, 12, 26, 29–32] but it cannot
be used routinely because of its cumbersomeness and
invasiveness. Thus, these invasive procedures are time and
cost-consuming as well as raise ethical concerns producing
scarring of the skin. To overcome this limita-tion, in vivo
confocal microscopy a new non-invasive in vivo imaging
can be used to visualize cells and structures in living skin
in real-time. This technique is less time-consuming and
non-invasive compared to his-tological analysis. The two
interesting objective methods are the cutometer and the 3D
imaging which are both non-invasive, reliable and easy to
use tools. Measuring instruments, including the
chromatometer, corneometer, tawameter, visiometer and
sebumeter, are increasingly used, [9, 10, 11, 16, 19, 20, 26,
33, 36, 38, 41, 43] allowing for quantitative results and an
objective com-parison between the baseline and the post-
treatment per-iod. These instruments are commonly used
in dermatological and cosmetic studies and have been suc-
cessfully applied. Various studies demonstrated accuracy
and reliability of these assessment tools but there is no
standard approach in the assessment of skin changes,
making direct comparisons between studies impossible.
Furthermore, a new face scale has been developed by
Panchapakesan et al. in 2013. The Face-Q Aging Appraisal
Scale is a revolutionary patient-reported outcome instru-
ment designed to assess the unique outcomes of patients
undergoing facial cosmetic procedures. The Face-Q mea-
sures outcomes in terms of satisfaction related to the
patient aspect and quality of life. According to Pancha-
pakesan and collaborators, this scale is highly reliable and
valid for assessing aesthetic treatments and cosmetic sur-
gical procedures [39]. However, to date, no clinical study
using this scale has yet been published.
Conclusion
This review will help in choosing adequate methods to
assess facial rejuvenation medical treatment. It is important
to combine these tools adequately to improve the assess-
ment. There is no current consensus on assessing facial
rejuvenation treatments but we noted that objective
assessment methods seem helpful.
Compliance with ethical standards
Conflict of Interest The authors declare that they have no conflict of
interest.
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References
1. Park KY, Ko EJ, Kim BJ, Kim MN, Hong CK, Chang SE, Won
CH, Lee YW (2015) A multicenter, randomized, double-blind
clinical study to evaluate the efficacy and safety of PP-501-B in
correction of nasolabial folds. Dermatol Surg 41(1):113–120
2. Shin SJ, Her Y, Yu DS, Kim CW, Kim SS (2014) Twenty-four-
week multicenter, evaluator-blinded clinical study of the efficacy
and safety of a dextran filler in the treatment of nasolabial folds.
Dermatol Surg 40:652–657
3. Goodier M, Elm K, Wallander I, Zelickson B, Schram S (2014)
A randomized comparison of the efficacy of low volume deep
placement cheek injection vs. mid- to deep dermal nasolabial
fold injection technique for the correction of nasolabial folds. J
Cos-met Dermatol 13:91–98
4. Choi SY, Lee YH, Kim H, Koh HJ, Park SY, Park WS, Bae IH,
Park KY, Kim BJ (2014) A combination trial of intradermal
radiofrequency and hyaluronic acid filler for treatment of naso-
labial fold wrinkles: a pilot study. J Cosmet Laser Ther
16(1):37–42
5. Brandt F, Bassichis B, Bassichis M, O’Connell C, Lin X (2011)
Safety and effectiveness of small and large gel-particle hya-
luronic acid in the correction of perioral wrinkles. J Drugs Der-
matol 10:982–987
6. Ascher B, Bayerl C, Brun P, Kestemont P, Rzany B, Poncet M,
Guennoun M, Podda M (2011) Efficacy and safety of a new
hyaluronic acid dermal filler in the treatment of severe nasolabial
lines—6-month interim results of a randomized, evaluator-blin-
ded, intra-individual comparison study. J Cosmet Dermatol
10(2):94–98
7. Ahn JY, Lee SH, Park KY, Hong CK, Song HJ, Park MY, Choi
YS, Seo SJ (2012) Clinical comparison of two hyaluronic acid-
derived fillers in the treatment of nasolabial folds: Mesoglow and
IAL System . Int J Dermatol 51(5):601–608
8. Sclafani AP (2010) Platelet-rich fibrin matrix for improvement
of deep nasolabial folds. J Cosmet Dermatol 9:66–71
9. Calabro` G, De Vita V, Patalano A, Mazzella C, Lo Conte V,
Antropoli C (2014) Confirmed efficacy of topical nifedipine in
the treatment of facial wrinkles. J Dermatolog Treat 25:319–325
10. Buntrock H, Reuther T, Prager W, Kerscher M (2013) Efficacy,
safety, and patient satisfaction of a monophasic cohesive poly-
densified matrix versus a biphasic nonanimal stabilized hya-
luronic acid filler after single injection in nasolabial folds.
Dermatol Surg 39:1097–1105
11. Royo de la Torre J, Moreno-Moraga J, Isarrı´a MJ, Mun˜oz E, Cruz
I, Pe´rez G, Cornejo P (2013) The evaluation of hyaluronic acid,
with and without lidocaine, in the filling of nasolabial folds as
measured by ultrastructural changes and pain management. J
Drugs Dermatol 12(3):e46–e52
12. Savoia A, Landi S, Baldi A (2013) A new minimally invasive
mesotherapy technique for facial rejuvenation. Dermatol Ther
(Heidelb) 3:83–93
13. Lee KR, Lee EG, Lee HJ, Yoon MS (2013) Assessment of
treatment efficacy and sebosuppressive effect of fractional
radiofrequency microneedle on acne vulgaris. Lasers Surg Med
45:639–647
14. Lee YB, Song EJ, Kim SS, Kim JW, Yu DS (2014) Safety and
efficacy of a novel injectable filler in the treatment of nasolabial
folds: polymethylmethacrylate and cross-linked dextran in hydrox-
ypropyl methylcellulose. J Cosmet Laser Ther 16(4):185–190
15. Pavicic T, Gauglitz GG, Lersch P, Schwach-Abdellaoui K, Malle B,
Korting HC, Farwick M (2011) Efficacy of cream-based novel
formulations of hyaluronic acid of different molecular weights in
anti-wrinkle treatment. J Drugs Dermatol 10(9):990–1000
123
Aesth Plast Surg (2016) 40:556–565
16. Bertucci V, Lin X, Axford-Gatley RA, Theisen MJ, Swift A
(2013) Safety and effectiveness of large gel particle hyaluronic
acid with lidocaine for correction of midface volume loss. Der-
matol Surg 39:1621–1629
17. Rzany B, Cartier H, Kestermont P, Trevidic P, Sattler G, Ker-
rouche N, Dhuin JC (2012) Correction of tear troughs and peri-
orbital lines with a range of customized hyaluronic acid fillers. J
Drugs Dermatol 11(1 Suppl):s27–s34
18. Kestemont P, Cartier H, Trevidic P, Rzany B, Sattler G, Ker-
rouche N, Dhuin JC (2012) Sustained efficacy and high patient
satisfaction after cheek enhancement with a new hyaluronic acid
dermal filler. J Drugs Dermatol 11(1 Suppl):9–16
19. Luebberding S, Krueger N, Kerscher M (2014) Comparison of
Validated Assessment Scales and 3D digital fringe projection
method to assess lifetime development of wrinkles in men. Skin
Res Technol 20:30–36
20. Ooe M, Seki T, Miura T, Takada A (2013) Comparative evalu-
ation of wrinkle treatments. Aesthetic Plast Surg 37:424–433
21. Clementoni MT, Lavagno R, Munavalli G (2012) A new multi-
modal fractional ablative CO2 laser for wrinkle reduction and
skin resurfacing. J Cosmet Laser Ther 14:244–252
22. Levenberg A, Halachmi S, Arad-Cohen A, Ad-El D, Cassuto D,
Lapidoth M (2010) Clinical results of skin remodeling using a
novel pneumatic technology. Int J Dermatol 49:1432–1439
23. Shin JW, Lee DH, Choi SY, Na JI, Park KC, Youn SW, Huh CH
(2011) Objective and non-invasive evaluation of photorejuvena-
tion effect with intense pulsed light treatment in Asian skin. J
Eur Acad Dermatol Venereol 5:516–522
24. Olivier Masveyraud F (2011) Facial rejuvenation using L-poly-
lactic acid: about 298 successive cases. Ann Chir Plast Esthet
56:120–127
25. Lorenc ZP, Bank D, Kane M, Lin X, Smith S (2012) Validation
of a four-point photographic scale for the assessment of midface
volume loss and/or contour deficiency. Plast Reconstr Surg
130:1330–1336
26. El-Domyati M, Abd-El-Raheem T, Medhat W, Abdel-Wahab H,
Al Anwer M (2014) Multiple fractional erbium: yttrium-alu-
minum-garnet laser sessions for upper facial rejuvenation: clini-
cal and histological implications and expectations. J Cosmet
Dermatol 13:30–37
27. Kim JE, Chang S, Won CH, Kim CH, Park KH, Choi JH, Lee MW
(2012) Combination treatment using bipolar radiofrequency-based
intense pulsed light, infrared light and diode laser enhanced clinical
effectiveness and histological dermal remodeling in Asian photoaged
skin. Dermatol Surg 38(1):68–76
28. Prignano F, Bonciani D, Campolmi P, Cannarozzo G, Bonan P,
Lotti T (2011) A study of fractional CO2 laser resurfacing: the
best fluences through a clinical, histological, and ultrastructural
evaluation. J Cosmet Dermatol 10:210–216
29. Koh BK, Lee CK, Chae K (2010) Photorejuvenation with sub-
millisecond neodymium-doped yttrium aluminum garnet (1064
nm) laser: a 24-week follow-up. Dermatol Surg 36:355–362
30. Tanaka Y, Tsunemi Y, Kawashima M, Tatewaki N, Nishida H
(2014) Treatment of skin laxity using multisource, phase-con-
trolled radiofrequency in Asians: visualized 3-dimensional skin
tightening results and increase in elastin density shown through
histologic investigation. Dermatol Surg 40:756–762
31. El-Domyati M, El-Ammawi TS, Medhat W, Moawad O, Maho-
ney MG, Uitto J (2012) Multiple minimally invasive erbium:
yttrium aluminum garnet laser mini-peels for skin rejuvenation:
an objective assessment. J Cosmet Dermatol 11:122–130
32. Patriota RC, Rodrigues CJ, Cuce´ LC (2011) Intense pulsed light
in photoaging: a clinical, histopathological and immunohisto-
chemical evaluation. An Bras Dermatol 86:1129–1133
Aesth Plast Surg (2016) 40:556–565
33. Jegasothy SM, Zabolotniaia V, Bielfeldt S (2014) Efficacy of a
new topical nano-hyaluronic acid in humans. J Clin Aesthet
Dermatol 7:27–29
34. Manosroi A, Chutoprapat R, Abe M, Manosroi W, Manosroi J
(2012) Anti-aging efficacy of topical formulations containing
niosomes entrapped with rice bran bioactive compounds. Pharm
Biol 50:208–224
35. Choi M, Choi JW, Lee SY et al (2010) Low-dose 1064-nm Q-
switched Nd:YAG laser for the treatment of melasma. J Der-
matolog Treat 21:224–228
36. Li YH, Chen JZ, Wei HC, Zhang L, Xu HH, Xu TH, Wu Y, Xu
YY, Dong GH, Gao XH, Chen HD, Gold MH (2010) A Chinese
experience of fractional ultrapulsed CO2 laser for skin rejuve-
nation. J Cosmet Laser Ther 12(6):250–255
37. Redaelli A, Romano D, Marciano´ A (2010) Face and neck revi-
talization with platelet-rich plasma (PRP): clinical outcome in a
series of 23 consecutively treated patients. J Drugs Dermatol
9:466–472
38. Mehryan P, Zartab H, Rajabi A, Pazhoohi N, Firooz A (2014)
Assessment of efficacy of platelet-rich plasma (PRP) on
infraorbital dark circles and crow’s feet wrinkles. J Cosmet
Dermatol 13:72–78
39. Panchapakesan V, Klassen AF, Cano SJ, Scott AM, Pusic AL
(2013) Development and psychometric evaluation of the FACE-
Q aging appraisal scale and patient-perceived age visual analog
scale. Aesthet Surg J 33:1099–1109
40. Lee HJ, Lee EG, Kang S, Sung JH, Chung HM, Kim DH (2014)
Efficacy of microneedling plus human stem cell conditioned
565
medium for skin rejuvenation: a randomized, controlled, blinded
split-face study. Ann Dermatol 26:584–591
41. Hong YH, Jung EY, Shin KS, Yu KW, Chang UJ, Suh HJ (2013)
Tannase-converted green tea catechins and their anti-wrinkle
activity in humans. J Cosmet Dermatol 12:137–143
42. Min P, Xi W, Grassetti L, Trisliana Perdanasari A, Torresetti M,
Feng S, Su W, Pu Z, Zhang Y, Han S, Zhang YX, Di Benedetto
G, Lazzeri D (2015) Sebum production alteration after botulinum
toxin type a injections for the treatment of forehead rhytides: a
prospective randomized double-blind dose-comparative clinical
investigation. Aesthet Surg J 35(5):600–610
43. Rose AE, Goldberg DJ (2013) Safety and efficacy of intradermal
injection of botulinum toxin for the treatment of oily skin. Der-
matol Surg 39:443–448
44. Roh M, Goo B, Jung J, Chung H, Chung K (2011) Treatment of
enlarged pores with the quasi long-pulsed versus Q-switched
1064 nm Nd:YAG lasers: a split-face, comparative, controlled
study. Laser Ther 20:175–180
45. El-Domyati M, El-Ammawi TS, Moawad O, El-Fakahany H,
Medhat W, Mahoney MG, Uitto J (2012) Efficacy of mesother-
apy in facial rejuvenation: a histological and immunohisto-
chemical evaluation. Int J Dermatol 51(8):913–919
46. Mahmood T, Akhtar N (2013) Combined topical application of
lotus and green tea improves facial skin surface parameters.
Rejuvenation Res 16:91–97
47. Kim M, Yang H, Kim H, Jung H, Jung H (2014) Novel cosmetic
patches for wrinkle improvement: retinyl retinoate and ascorbic acid-
loaded dissolving microneedles. Int J Cosmet Sci 36:207–212
123