Validated Assessment Scales for Décolleté Wrinkling and Pigmentation.

Decollete aging includes skin dyspigmentation, laxity, and visible wrinkling. The development of globally accepted scales for the assessment of decollete aging is essential for aesthetic research and patient evaluation.To develop a set of grading scales for the objective assessment of decollete aging criteria and establish the reliability and validity of these scales.To describe age-related changes to the decollete, 3 photonumeric grading scales were created and validated: decollete wrinkles-at rest, decollete wrinkles-dynamic, and decollete pigmentation-at rest. Thirteen aesthetic experts rated photographs of the decollete of 50 women at rest and at dynamic "hand-to-elbow" positions in 2 validation sessions. Responses were analyzed to assess interrater and intrarater reliability.Interrater and intrarater reliability were both "almost perfect" (≥0.81, intraclass correlation coefficient and weighted kappa) for decollete wrinkles-dynamic, summary score for decollete, and estimated age. Reliability was "substantial" (0.61-0.80) for all other decollete assessments. There was high correlation between all decollete scales, estimated age, and estimated aesthetic treatment effort.Consistent outcomes between raters and by individual raters at different time points confirm the reliability of the decollete grading scales, indicating that they will be a valuable tool for use in clinical research and practice.