Development and validation of a 6-point grading scale in patients undergoing correction of nasolabial folds with a collagen implant.

BACKGROUND: Various scoring techniques prone to subjective interpretation have been used to evaluate soft tissue augmentation of nasolabial folds (NLFs). OBJECTIVE: To design and validate a reliable wrinkle assessment scoring scale. MATERIALS AND METHODS: Six photographed wrinkles of varying severity were electronically copied onto the same facial image to become a 6-point grading scale (GGS). A pilot training program (13 investigators) determined reliability, and a 12-week multicenter survey study validated the GGS scoring method. RESULTS: Pilot study inter- and intrarater scoring reliability were high (weighted kappa scores of 0.85 and 0.86, respectively). Seventy-five percent of survey investigators and independent review panel (IRP) members considered a GGS score difference of 0.5 to be a minimally perceivable difference. Interrater weighted kappa scores were 0.91 for the IRP and 0.80 for investigators. Intrarater agreements after repeat testing were 0.91 and 0.89, respectively. The baseline "live" assessment GGS mean score was 3.34, and the baseline blinded photographic assessment GGS mean score was 2.00 for the IRP and 2.16 for the investigators. CONCLUSIONS: The GGS is a reproducible method of grading the severity of NLF wrinkles. Treatment effectiveness of a dermal filler can be reliably evaluated using the GGS by comparing "live" assessments with the standard GGS photographic panel.

Treatment of periorbital hyperpigmentation.

Periorbital hyperpigmentation is a generally benign, extremely common condition that is notoriously resistant to treatment. According to the author, the key to successful treatment is determining the primary cause and complying with maintenance and preventive regimens. A multimodal approach may be required, encompassing topical bleaching agents, chemical peels, laser therapy, and/or surgery.