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Intra- and inter-observer reliability of the application of the cellulite severity scale to a Spanish female population


  • Conflict of interest
    None declared.

  • Funding sources
    None declared.

M. De La Casa Almeida.


Background  ‘Hexsel, dal’Forno and Hexsel Cellulite Severity Scale’ (CSS) was developed to evaluate cellulite with an objective and easy to apply tool.

Objective  Study CSS intra- and inter-observer reliability in a Spanish female population by evaluating patients’ cellulite through photographs of their overall gluteofemoral zone as opposed to its creators who distinguished between buttocks and thigh.

Methods  Cellulite Severity Scale was applied to 27 women, evaluating gluteofemoral cellulite, differentiating between left and right. Evaluations were made by three expert examiners each at three times with a 1-week separation. Variables were the five CSS dimensions (number of evident depressions; depth of depressions; morphological appearance of skin surface alterations; grade of laxity, flaccidity, or sagging skin; and the Nürnberger and Müller classification scale), and the overall CSS score. Cronbach’s alpha, intra-class correlation and item total correlation were analysed.

Results  Cronbach’s alpha values were 0.951 (right) and 0.944 (left). In the intra-observer reliability analysis, intra-class correlation coefficient ranged from 0.993 to 0.999 (< 0.001) and in the inter-observer analysis were 0.937 (right) and 0.947 (left) (< 0.001). Item total correlation showed all dimensions to be needed except grade of laxity, flaccidity or sagging skin (0.959 right; 0.955 left).

Conclusion  Cellulite Severity Scale has excellent reliability and internal consistency when used to evaluate cellulite on the buttocks and back of the thighs considered together. Nevertheless, the dimension grade of laxity, flaccidity or sagging skin does not contribute positively to the final consistency of the scale. This dimension needs to be analysed in greater depth in future studies.