Carruthers et al developed a simple scale for grading forehead lines. This can aid in the evaluation of a patient requesting plastic surgery. The authors are from multiple institutions in Canada, the United States and Germany.
Forehead lines are multiple horizontal lines that occur at regular intervals across the forehead.
The severity of crow's feet depends on:
(1) history of smoking
(2) exposure to ultraviolet light
(3) other environmental exposures
(4) disorders of collagen and elastin fibers
(5) genetic predisposition
The appearance of forehead lines may be affected by:
(1) contraction of muscles while making facial expressions
(2) lighting
(3) application of cosmetics and "anti-wrinkle" creams.
Scale
Wrinkles at Rest
Wrinkles with Facial Expression
0
none
none
1
none
fine
2
fine
deep
3
fine
deeper
4
deep
deep furrows
The examination should be standardized as much as possible, especially if the patient is to be followed over time. Photographs under the same lighting condition can improve the consistency of grading.
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