Introduction: Differences between professionals assessing the aging mid-face, including proposed management vary. To obtain some insight into the nature and the extent of variable opinions, the study on inter-rater reliability and concordance was designed.

Material and Method: Photographic images of forty standardized patients were presented to 6 senior board certified plastic surgeons (over 6 years in independent practice), to 6 junior non-board certified plastic surgeons (less than 3 years in practice) and to 6 plastic surgery residents for their assessment of nasolabial fold, cheeks, perioral area and delineation of management priorities.

Results: The reliability of each item was calculated using percent agreement and the kappa coefficient. Total percent agreement ranged from 62% in the resident group to 63% in the junior plastic surgeons and 90% in the senior plastic surgeons on assessment and 73%, 75% to 95% on management in respective groups.

Conclusions: Study findings indicated that the most senior plastic surgeons' assessments had the highest level of concordance while the junior plastic surgeons and the resident groups produced variations with less regularity. Such discrepancies are expected and critical in a teaching centre as the education should focus on this aspect of care.

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