When it comes to using wrinkle classification systems, like Glogau, Merz or Fitzpatrick, some aesthetic physicians swear by them. Others would rather look at wrinkles as “mild,” “moderate” or “severe.”
American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) President Fred G. Fedok, M.D., says he uses specific wrinkle scales in his aesthetic practice to ascertain which treatments would be effective and safe in a given patient.
“I use two scales commonly when considering patients for resurfacing procedures — the Glogau and the Fitzpatrick scales,” he says. “I use the Glogau to characterize the patient to help guide the type of treatment and the aggressiveness of treatment. For instance, in patients with a lesser Glogau rating, I expect them to display less photoaging changes compared to those with a higher rating. In those former patients I may consider it most appropriate to do a lighter peel or use a less aggressive laser setting.”
Dr. Fedok says the Fitzpatrick scale tells him about skin type, the amount of melanin in a patient’s skin and the patient’s propensity for pigmentation complications, secondary to resurfacing.
“Those with a lessor Fitzpatrick type, will do well with many types and depths of resurfacing. Those with a higher Fitzpatrick designator will have to be treated quite cautiously,” Dr. Fedok says.
Princeton, N.J. plastic surgeon Adam Hamawy, M.D., says his scale of choice is the Glogau Wrinkle Scale, because it offers a good global assessment of the face.
“When I need to get more specific, I use the Merz scale for the specific region of the face,” Dr. Hamawy says.
But like many doctors who do aesthetic procedures, Dr. Hamawy thinks wrinkle scales are not used much in clinical practice.
“Scales are usually used to provide objective quantification of improvement in facial wrinkles after injection of a neurotoxin like Botox or a filler. They are most useful in research when assessing how effective an injectable treatment is. They are not typically used in routine, everyday clinical evaluations or treatments,” Dr. Hamawy says.