The Modified Fitzpatrick Wrinkle Scale: A Clinical Validated Measurement Tool for Nasolabial Wrinkle Severity Assessment

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The number of existing wrinkle assessment scales makes it difficult to compare the efficacy of cosmetic techniques in rejuvenating photoaged skin. A single and simple assessment scale that reliably quantifies wrinkle depth is needed.


The objective was to validate the Modified Fitzpatrick Wrinkle Scale (MFWS) as a nasolabial wrinkle severity assessment tool.


The MFWS comprises three main classes, in which definitions are based on a set of reference photographs and descriptions, and three interclasses, in which definitions are based only on descriptions. Assessors were trained to apply this scale to volunteers and study patients by using photographs of nasolabial wrinkles either alone or with descriptions. Inter- and intraassessment reliability coefficients were calculated using weighted kappa statistics.


In patients, the combined intraassessor reliability from both sides of the face was 0.71 (95% confidence interval [CI], 0.68–0.74) when only photographs were used and 0.79 (95% CI, 0.76–0.82) when descriptions were added. Interassessor reliability for the photographs alone was 0.65 (95% CI, 0.62–0.68) and 0.74 (95% CI, 0.69–0.79) for photographs plus descriptions.


The MFWS is a reliable method for quantitative assessment of nasolabial skin folds, with good inter- and intraassessor reliability. Including descriptions with the photographs increased reliability.

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