A Validated Assessment Scale for the Auriculocephalic Angle in Asians

BACKGROUND: The auriculocephalic angle, a key determinant of the facial outline, varies significantly across populations and plays a pivotal role in aesthetic preferences. In the East Asian population, larger auriculocephalic angles are associated with positive attributes, while smaller angles disrupt facial proportions, leading to visual distortions akin to the Ebbinghaus illusion. Despite its importance, objective tools for assessing this angle remain limited. OBJECTIVE: To develop and validate the Imeik Lying Ears Severity Scale (ILESS), a standardized photonumeric scale for the evaluation of the auriculocephalic angle. METHODS: A photography database of 96 participants was created using standardized 2D photography protocols. The ILESS scale, spanning grades 0-4, was developed and validated via digital assessments of 12 experts across two sessions and live evaluations by six experts using a total of 158 ears. Statistical analyses included intraclass correlation coefficients (ICCs) and weighted Cohen's kappa for inter- and intra-rater reliability. RESULTS: Digital validation across both sessions showed excellent inter-rater reliability (ICC: 0.90; weighted kappa: 0.89-0.90), while live validation confirmed strong agreement (ICC: 0.82-0.85; weighted kappa: 0.82-0.85). Intra-rater reliability consistently exceeded ICC and kappa values of 0.89, indicating high reproducibility. CONCLUSION: The ILESS scale offers a robust and versatile tool for the standardized assessment of auriculocephalic angles. Its validation in digital and live settings underscores its applicability in clinical practice and research. The ILESS scale sets a new benchmark in aesthetic evaluation, supporting precise treatment planning and advancing evidence-based aesthetic medicine. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .