he fields of plastic and reconstructive surgery, dermatology, and aesthetic medicine are concerned with changes in visual states of being. Whether seeking to improve the appearance of the aging face or reconstruct the diseased or damaged body, health care providers seek to move patients from a suboptimal state to a second state that is improved. To evaluate the success of therapeutic maneuvers, effective descriptions of changes in visual state are needed. This process requires that the appreciation of the first state and those that follow is valid and reliable (Fig. 1). Although visual assessment appears to be inherently subjective, there is a growing trend of largescale megadata that provide the necessary power for validation and reliability. This has the potential to transform the future of aesthetic medicine from the subjective into the objective. This review attempts to evaluate the current state of validated visual scales in the fields of dermatology, plastic

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