Comparison of Clinical Outcome Parameters, the Patient Benefit Index (PBI-k) and Patient Satisfaction After Ablative Fractional Laser Treatment of Pen-Orbital Rhytides

Background: Laser treatment of facial rhytides has evolved as a major modality of aesthetic surgery. Published results, while generally encouraging, feature highly diverse evaluation methods, which makes an evidence-based assessment of treatment efficacy and safety all but impossible. Objective: To compare the results of different instruments of measurement. Patients/Methods: Twenty-eight patients were enrolled and completed the entire study. They received a single ablative fractional treatment of the pen-orbital region. The evaluation included the Fitzpatrick wrinkle score, the profilometric measurement of wrinkle depth and the Patient Benefit Index (both before and 3 months after treatment) as well as the assessment of patient satisfaction (1, 3, 6 days and 3 months after treatment). Results: All assessment instruments showed a significant, albeit moderate, improvement. The agreement between assessment methods was poor. Despite claiming to assess basically the same parameter, the Fitzpatrick wrinkle score and profilometry differed significantly, and neither assessment instrument showed any appreciable correlation with any other. Conclusions: The outcome assessment of rhytide therapy regardless of the method used shows substantial room for improvement. Strict methodological precautions ought to be applied for 'objective' evaluation methods like photographic scoring and profilometry. Subjective methods of assessment are essential and might serve as a main outcome parameter. Finally, critical reappraisal of published treatment results seems warranted to review the quality of their methodology. Lasers Surg. Med. 42:215-223, 2010. (C) 2010 Wiley-Liss, Inc.