Fine Lines and Skin Texture in Daegu — May They Be Grouped Into One Treatment?
“My fine lines and my skin texture have both got worse” is a sentence that comes up in consultation almost always as a pair. And yet in the literature these two are graded from the outset on separate scales — the scale that measures fine lines and the scale that measures roughness were developed separately, and they look at different areas. What is more, the reliability of those scales differs noticeably from area to area. We write that state of affairs down first, and on top of it we set out what we separate.
The conclusion, first
“Where in Daegu is good at fine lines and skin texture?” is a question that cannot be settled from public data. So we write a different answer instead — we set out how the two are measured separately in the data, and we say what we separate them on. There are three points. First, fine lines and roughness are each graded on separate scales made by the same development group — the fine lines scale looks at “superficial fine lines,” while the roughness scale looks at “coarseness of texture · crisscross lines · elastosis.” Second, on every one of these scales, agreement between raters is lower than agreement within a rater (fine lines scale: κ 0.85 when one person repeats, against 0.76 between different people). Third, the difference in reliability between areas is large — the inter-rater intraclass correlation coefficient for the glabellar · crow’s feet · forehead scales is 0.94 to 0.98, whereas inter-rater agreement for the scale devoted to infraorbital fine lines is Fleiss’ κ 0.61. So instead of bundling them together and saying “we will improve your fine lines and your skin texture at the same time,” we first separate out which of the two is the main complaint, and tell you alongside it how much the assessment moves about in that area.
The order we actually work through in consultation
1. We separate lines from texture from pores
The three differ in the kind of shadow the light makes. Fine lines are lines with a direction, texture is fine unevenness without a direction, and pores are point-shaped depressions. The three are often present together, but the class of treatment changes according to which is the main complaint. The situation on the pores side we have written out in when pores look enlarged, and on the texture side in when you feel your skin texture has grown rough.
2. We set out what the two scales actually look at
| Scale | What it looks at | Validation sample and reliability |
|---|---|---|
| Fine lines scale (5-point) | Severity of superficial fine lines | 289 live subjects · two sessions three weeks apart. Weighted κ on repetition by the same rater 0.85, between raters 0.76 |
| Skin roughness scale (5-point) | Coarseness of texture · crisscross lines · elastosis in the midface | A separate scale from the same development line. Grade definitions run from “smooth” to “severe elastosis” |
| Glabellar · crow’s feet · forehead scales (4-point) | Lines at rest and at maximum expression | 96 to 114 subjects · five board-certified raters. Inter-rater intraclass correlation coefficient 0.94 to 0.98 |
| Infraorbital fine lines scale (5-point) | Horizontal fine lines of the lower eyelid | 53 subjects · five dermatologists. Inter-rater Fleiss’ κ 0.61, intra-rater κ 1.00 |
Look at the right-hand column of the table and the accuracy of the measurement differs from area to area. On the glabella and the forehead, raters give almost the same score; but below the eye, the score changes noticeably when the rater changes. And yet, when “the fine lines have improved” is said in clinical practice, the person judging is usually one person, and that one person is usually the person who carried out the treatment. That agreement is high when the same rater repeats (κ 1.00 on the infraorbital scale) also means that it is favourable for a before-and-after comparison but cannot be used for comparison between institutions.
3. We also look at what comes out when it is measured by machine
There is also material in which texture was measured with equipment rather than by photographic grade. In a retrospective study measuring the crow’s feet area with a device that projects light of several wavelengths from several directions to measure the surface, after an injection of 12 units of botulinum toxin the coarseness of the texture fell by 17.08% at four weeks (p < 0.0001) and by 12.14% at four months (p = 0.001). This study measured texture separately after filtering out wrinkles deeper than 0.5 mm — that is, fine lines and texture are separated and measured apart even mechanically. That said, it is a retrospective study and there was no control group.
4. We separate out the time axis
Texture is a matter of the surface and fine lines straddle the surface and the dermis, so the point at which change becomes visible differs. The point at which each treatment can be judged we have set out in from when can the result be judged. Even when they start on the same day, we do not judge them on the same day.
5. So this is the order we decide in
(1) We separate out whether the main complaint is lines, unevenness or points → (2) we tell you how much the assessment moves about in that area → (3) for each candidate class we set out what has been measured in people and how many people the sample was → (4) items that have not been verified we say have not been verified → (5) and on top of that we decide together. Price and discounts enter nowhere in this order; costs are explained separately at the consultation.
Five things worth asking at a consultation
These are questions you can ask at any clinic. If the answers are specific and the place says it does not know what it does not know, that helps a judgement.
- “In my case, is the main problem lines or texture?” — an answer that does not separate the two leaves no basis for choosing a class.
- “What do you judge improvement by?” — whether it is a photographic grade or an instrument reading, and how many people do the judging.
- “Is this an area where the assessment moves about a lot?” — below the eye is an area where inter-rater agreement is low in the literature too.
- “How many people was that evidence based on?” — whether there was a control group, and whether it was retrospective or prospective.
- “In what circumstances does it tend not to work?” — an explanation that does not state the limits is not material for a judgement.
What is confirmed / what is inferred / what we could not confirm / material pointing the other way
| Category | Content |
|---|---|
| Confirmed | That the fine lines scale and the roughness scale were developed separately and are graded separately. Intra-rater weighted κ 0.85 against inter-rater 0.76 for the fine lines scale (289 people). Inter-rater intraclass correlation coefficient 0.94 to 0.98 for the glabellar · crow’s feet · forehead scales (96 to 114 people). Inter-rater Fleiss’ κ 0.61 for the infraorbital fine lines scale (53 people). A fall in crow’s feet texture coarseness of 17.08% at four weeks · 12.14% at four months after botulinum toxin (retrospective, no control group). |
| Inferred | We take the view that the bundled phrase “improving fine lines and skin texture together” is at odds with the reality of the measurement — because the literature grades the two apart from the outset. And in an area such as below the eye where the assessment moves about, we take the view that a verdict of “improved” delivered by a single rater carries less weight than in other areas. This, though, is our interpretation. |
| Could not confirm | A randomised controlled trial measuring fine lines and texture at the same time on their own scales within one study and comparing classes against each other. Where a manufacturer was involved in developing a scale, the effect of that conflict of interest on the grade definitions. Trials, product by product among those distributed in Korea, with texture coarseness as the primary endpoint. Primary sources for how long the texture improvement of each class lasts. |
| Material pointing the other way | That inter-rater agreement is low does not mean “the scale is useless.” Even on the infraorbital scale, κ was 1.00 when the same rater repeated and overall agreement was above 80%. That is, it can perfectly well be used for a before-and-after comparison in one person. And a good many of the scales cited in this article were developed or funded by manufacturers, so to be fair one has to set alongside them the fact that the reliability figures themselves carry a conflict of interest. |
Where this article was written
- Miso Clinic, Daegu · 4F Bombom Building, 125 Dongdeok-ro, Jung-gu, Daegu, Republic of Korea (near Kyungpook National University Hospital station)
- Director Lee Chi-Hak · Tel. 053-428-2700
- This column was written by the director and reviewed in September 2026.
This article was written not to recommend a particular treatment but to set out the extent of the data needed for a decision. Judgement about an individual condition requires examination, and this article does not substitute for medical care. As companion pieces it helps to read comparing types of skin booster in Daegu — what has been verified class by class and choosing a skin firmness treatment in Daegu.
Frequently asked questions
Which hospital in Daegu is good at fine lines and skin texture?
This is a question that cannot be answered from data, because no public metric comparing practitioners’ skill exists. Instead, ask “in my case, is the main problem lines or texture?”, and it is better to choose a place that answers by separating the two and goes on to say how much the assessment in that area moves about. That is because the literature measures fine lines and roughness on separate scales from the outset.
Are fine lines and skin texture dealt with by the same treatment?
There are cases in which both improve with the same treatment, but that is not the same as having verified them by measuring the same thing. In the literature fine lines are graded on a severity scale for fine lines, and texture separately on a roughness scale or by surface instrument reading. Indeed, in the instrument study texture alone was measured after filtering out wrinkles deeper than 0.5 mm. So we ask first which of the two is the main complaint.
Why are fine lines below the eye hard to judge?
Inter-rater agreement for that area comes out low in the literature as well. In the validation study of the scale devoted to infraorbital fine lines (53 people, five dermatologists), inter-rater Fleiss’ κ was 0.61 — a large difference set against the inter-rater intraclass correlation coefficient of 0.94 to 0.98 for the glabellar · crow’s feet · forehead scales. That said, κ was 1.00 when the same rater repeated, so a before-and-after photographic comparison under the same conditions is valid.
If a photograph is said to show improvement, can I trust it?
The weight differs according to who judged it and how many of them there were. Even with a validated scale the score changes when the rater changes, and the size of that swing differs by area. And in clinical practice the person delivering the verdict of “improved” is usually the one person who carried out the treatment. We do use photographic judgement, but we say alongside it that unless the lighting, the angle and the expression are the same, the comparison does not hold in the first place.
What improves skin texture?
Each class measures something different, so it is hard to give one answer. The approach that works on surface keratin and reflection, the approach that increases dermal thickness, and the approach that reduces surface folding by reducing muscle movement each hold different data. For instance, the botulinum toxin material reports that texture coarseness at the crow’s feet fell by 17.08% at four weeks, but it is a retrospective study and there was no control group. We tell you the sample size and design of each candidate alongside it.
From when is the result judged?
It differs by class, and even when they start on the same day we do not judge them on the same day. Change on the surface side shows relatively early, and change on the dermal side shows late. The situation at each point in time we have set out in from when can the result be judged. We ask you not to judge by the impression on the day of the treatment or the day after.
Who wrote this
Written and reviewed by Lee Chi-Hak, MD, medical director of Miso Clinic in Daegu, South Korea. Every study cited above is given together with its design, its size and the limitations the authors themselves recorded, and where we could not find data, we have said that we could not find any.
| Medical director | Lee Chi-Hak, MD |
|---|---|
| Address | 4F Bombom Building, 125 Dongdeok-ro, Jung-gu, Daegu, South Korea · Exit 1, Kyungpook National University Hospital Station |
| Phone | +82-53-428-2700 |
| Hours | Weekdays 11:00–19:00 (lunch 13:00–14:00) / Saturday 10:00–16:00 (no lunch break) / Closed Sundays and public holidays |
| Columns | All clinical columns |
| Reference library | All booster and device references |
References
- Development and validation of the fine lines scale — Carruthers J, Donofrio L, Hardas B, Murphy DK, Jones D, Carruthers A, Sykes JM, Creutz L, Marx A, Dill S, Dermatologic Surgery 2016;42(Suppl 1):S227–S234, PMID 27661745, DOI 10.1097/DSS.0000000000000847. 289 live subjects · two sessions three weeks apart. Intra-rater weighted κ 0.85, inter-rater at the second session 0.76. This is a study that included authors employed by the manufacturer (Allergan).
- Validation of the glabellar · crow’s feet · forehead scales — Lorenc ZP, Smith S, Bass LS, Bloom JD, Downie J, Jones D, Moradi A, Lee W, Go S, Aesthetic Surgery Journal Open Forum 2025;7:ojaf124, PMID 41245226, DOI 10.1093/asjof/ojaf124. 96 to 114 subjects per scale · five board-certified raters · two sessions at least two weeks apart. Intra-rater mean 0.83 to 0.91, inter-rater intraclass correlation coefficient 0.94 to 0.98.
- The scale devoted to infraorbital fine lines — Choi SY, Kim BJ, Journal of Cosmetic Dermatology 2026;25(1):e70583, PMID 41508421, DOI 10.1111/jocd.70583. 73 standardised photographs of 53 adults (including 20 duplicates) · five dermatologists. Inter-rater Fleiss’ κ 0.6114, intra-rater Cohen’s κ 1.0000, overall agreement above 80%. A manufacturer’s name appears in the name of the scale, and it should be read with the conflict of interest in mind.
- Texture coarseness measured by instrument — Cavallini M, Papagni M, Gazzola R, Skin Research and Technology 2019;25(1):54–59, PMID 29873844, DOI 10.1111/srt.12595. Crow’s feet texture coarseness measured with a multi-wavelength · multi-direction light source device (Antera 3D). After an injection of 12 units of botulinum toxin, a fall of 17.08% at four weeks (p < 0.0001) and a fall of 12.14% at four months (p = 0.001). Texture alone was measured after filtering out wrinkles deeper than 0.5 mm. It is a retrospective study and there was no control group.
- The prototype of the wrinkle severity scale — Day DJ, Littler CM, Swift RW, Gottlieb S, American Journal of Clinical Dermatology 2004;5(1):49–52, PMID 14979743, DOI 10.2165/00128071-200405010-00007. Five raters graded 30 photographs of the lower face on a five-point scale. Intra-rater agreement 68.7% · 72.7%, inter-rater agreement 67.7% · 72.3% (weighted κ 0.75 · 0.78). We record that the original agreement of a widely used scale is at the level of two thirds.
- The grade definitions of the skin roughness scale — a five-point scale grading coarseness of texture · crisscross lines · elastosis in the midface (from the nasolabial fold to in front of the ear, from below the eye to the jaw) from 0 (smooth) to 4 (severe). It is a separate scale from the fine lines scale, with a separate definition of the area.
- Legislation on medical advertising — Article 56(2) of the Korean Medical Service Act. It prohibits advertising by means of accounts of treatment experience, comparison with other medical institutions, superlative expressions and the like. This is why this column carries no expressions such as “good at” or “the best,” no comparison with other medical institutions, and no prices or discounts.
Everything in this column is general information and does not replace medical diagnosis or treatment. Effects and side effects vary with individual skin condition, age and underlying illness, and the same result is not guaranteed for everyone. Any decision to proceed should be made in an in-person consultation with a physician.
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