Validated Assessment Scales for Décolleté Wrinkling and Pigmentation

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Décolleté aging includes skin dyspigmentation, laxity, and visible wrinkling. The development of globally accepted scales for the assessment of décolleté aging is essential for aesthetic research and patient evaluation.


To develop a set of grading scales for the objective assessment of décolleté aging criteria and establish the reliability and validity of these scales.


To describe age-related changes to the décolleté, 3 photonumeric grading scales were created and validated: décolleté wrinkles—at rest, décolleté wrinkles—dynamic, and décolleté pigmentation—at rest. Thirteen aesthetic experts rated photographs of the décolleté 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 décolleté wrinkles—dynamic, summary score for décolleté, and estimated age. Reliability was “substantial” (0.61–0.80) for all other décolleté assessments. There was high correlation between all décolleté 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 décolleté grading scales, indicating that they will be a valuable tool for use in clinical research and practice.

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