Age- and fatigue-related markers of human faces: an eye-tracking study

Clinical efficacy and safety of composite non-cross-linked hyaluronic acid for treating tear trough-lower eyelid bag deformity

BACKGROUND

Tear trough-eye bag deformities may appear in young Asian patients due to the weak support of their facial skeletons. For these patients with better periorbital skin elasticity, the injection may be more suitable than surgery for treating tear trough-lower eyelid bag deformity.

AIMS

Identify the clinical efficacy and safety of non-cross-linked HA in the treatment of tear trough-lower eyelid bag deformity.

METHODS

In this study, we analyzed pre- and postinjection photographs of 55 patients treated with non-cross-linked hyaluronic acid (HA) for tear trough-lower eyelid bag deformity.

RESULTS

The mean [SD] scores of modified Goldberg score suggested that the most significant improvement of preoperative and postoperative scores was in tear trough depression, followed by infraorbital triangular depression, orbital fat prolapse, loss of skin elasticity, and skin transparency. Only transient localized complications were observed, including bruising, swelling, and erythema. There were no serious complications, such as skin necrosis or visual impairment.

CONCLUSIONS

Our study confirmed the beneficial efficacy and minor complications of composite non-cross-linked HA for the treatment of tear trough-lower eyelid bag deformity.

Clues for Facial Perceived Age: Exercise, Sun Protection, Photoaging, and Anthropometric Properties: An Observational Cross-Sectional Study

BACKGROUND AND OBJECTIVES

The effect of environmental and genetic factors on the aging process is widely acknowledged. Yet, the extent to which each factor decisively contributes to the perception of looking younger or older remains a subject of debate. This study seeks to identify the factors linked to the perceived age among Turkish women.

PATIENTS AND METHODS

Ten assessors scored the perceived ages of 250 female patients based on facial photographs. The study aimed to assess the impact of environmental factors and anthropometric measurements on the perception of aging. A comprehensive analysis involved conducting 9 perioral and 6 periorbital anthropometric measurements on all study participants.

RESULTS

Exercise (p = .001), mild photodamage (stage 1-2) (p = .001), consistent sunscreen use (p = .001), the length of the palpebral fissure (p = .043), and the height of the upper vermilion (p = .019) demonstrated significant associations with a more youthful appearance.

CONCLUSION

Environmental factors, including exercise, photoprotection, sunscreen use, and anthropometric measurements such as palpebral fissure length and upper vermilion height, play a significant role in contributing to a more youthful appearance.

Facial adult female acne in China: An analysis based on artificial intelligence over one million

BACKGROUND

To further clarify the acne profile of Chinese adult women, we included 1,156,703 adult women. An artificial intelligence algorithm was used to analyze images taken by high-resolution mobile phones to further explore acne levels in Chinese adult women.

METHOD

In this study, we assessed the severity of acne by evaluating patients' selfies through a smartphone application. Furthermore, we gathered basic user information through a questionnaire, including details such as age, gender, skin sensitivity, and dietary habits.

RESULTS

This study showed a gradual decrease in acne severity from the age of 25 years. A trough was reached between the ages of 40 and 44, followed by a gradual increase in acne severity. In terms of skin problems and acne severity, we have found that oily skin, hypersensitive skin, frequent makeup application and unhealthy dietary habits can affect the severity of acne. For environment and acne severity, we observed that developed city levels, cold seasons and high altitude and strong radiation affect acne severity in adult women. For the results of the AI analyses, the severity of blackheads, pores, dark circles and skin roughness were positively associated with acne severity in adult women.

CONCLUSIONS

AI analysis of high-res phone images in Chinese adult women reveals acne severity trends. Severity decreases after 25, hits a low at 40-44, then gradually rises. Skin type, sensitivity, makeup, diet, urbanization, seasons, altitude, and radiation impact acne. Blackheads, pores, dark circles, and skin roughness are linked to acne severity. These findings inform personalized skincare and public health strategies for adult women.

Predicting human chronological age via AI analysis of dorsal hand versus facial images: A study in a cohort of Indian females

Predicting a person's chronological age (CA) from visible skin features using artificial intelligence (AI) is now commonplace. Often, convolutional neural network (CNN) models are built using images of the face as biometric data. However, hands hold telltale signs of a person's age. To determine the utility of using only hand images in predicting CA, we developed two deep CNNs based on 1) dorsal hand images (H) and 2) frontal face images (F). Subjects (n = 1454) were Indian women, 20-80 years, across three geographic cohorts (Mumbai, New Delhi and Bangalore) and having a broad variation in skin tones. Images were randomised: 70% of F and 70% of H were used to train CNNs. The remaining 30% of F and H were retained for validation. CNN validation showed mean absolute error for predicting CA using F and H of 4.1 and 4.7 years, respectively. In both cases correlations of predicted and actual age were statistically significant (r(F) = 0.93, r(H) = 0.90). The CNNs for F and H were validated for dark and light skin tones. Finally, by blurring or accentuating visible features on specific regions of the hand and face, we identified those features that contributed to the CNN models. For the face, areas of the inner eye corner and around the mouth were most important for age prediction. For the hands, knuckle texture was a key driver for age prediction. Collectively, for AI estimates of CA, CNNs based solely on hand images are a viable alternative and comparable to CNNs based on facial images.

Applications of the new Aeva-HE™ imaging system: Its link with the visual evaluation of facial wrinkles and its potential in screening tensile products

OBJECTIVES

To evaluate, in vivo, a recently developed imaging system (Aeva-HE™), based on fringe projection methodology: (i) its correlation with expert's assessments and real age of 85 French Caucasian women and (ii) its potential, as a screening tool, in rapidly selecting prototypes of tensile cosmetic products.

MATERIALS AND METHODS

First, the bare faces of 85 differently aged French/Caucasian women were photographed under standard conditions and further analyzed by the Aeva-HE™ device. An expert aesthetician graded the severity of wrinkling on a fixed scale, helped by the use of a dedicated Skin Aging Atlas. A panel of 15 judges performed the same task on full-face standard photographs. The Aeva-HE™ software yielded various wrinkle's parameters (density, volume, mean depth, etc.) on different facial locations, according to age-groups. Second, seven women, balanced in age and wrinkling severity, were recruited in a separate study. These women applied at Day 1 a prototype of the tensile product and at Day 2, they applied another prototype of the tensile product. The whole faces (before and after products application) of the seven studied women were captured and analyzed by the Aeva-HE™ system.

RESULTS

The density of wrinkles was significantly highly correlated with the aesthetician scores and, unsurprisingly, with age. Some parameters (volume, depths) of different wrinkles (glabellar, crow's feet, cheeks) were quantified, showing different absolute values and of statistically different progressions with age. The amplitudes of the rapid effects brought by the two prototypes of tensile products were clearly differentiated.

CONCLUSION

The recently developed device Aeva-HE™ is an efficient system for rapidly establishing a faithful and precise status of facial wrinkles, in vivo and seems like a precious tool in the rapid screening of tensile products, possibly performed on a rather limited number of subjects.

Artificial intelligence analysis of over a million Chinese men and women reveals level of dark circle in the facial skin aging process

BACKGROUND

To better compare the progression of dark circles and the aging process in Chinese skin. A total of 100 589 Chinese males and 1 838 997 Chinese females aged 18 to 85, without facial skin conditions, and who had access to a smartphone with a high-resolution camera all took selfies.

METHOD

Using a smartphone application with a built-in artificial intelligence algorithm, facial skin diagnostic evaluated the selfies and score the severity of the dark circles with four other facial indicators (including skin type, Pores, Acne vulgaris, and Blackheads). Basic information was collected with online questionnaire, including their age, gender, skin sensitivity, and dietary habits.

RESULTS

In users between the age of 18 and 59, the prevalence of comprehensive, pigmented, and structural type of dark circles all rose with age. However, between the age of 60 and 85, the intensity of all types of dark circles diminished. Besides, vascular dark circles progressively worsen from the age of 18 to their peak at 39, and then gradually decline with age. Females typically have more pronounced black circles under their eyes than males in China. Bad eating habits, urbanization, regular cosmetics use, and sensitive skin positively correlate with severe dark circles. Vascular, comprehensive dark circles were worse in spring. Both pigmented and structural dark circles were worse in the summer. The results indicated that the intensity of dark circles was influenced by oily skin, wide pores, severe blackheads, and severe acne.

CONCLUSIONS

Chinese men and women differed noticeably in the prevalence of each face aging indicator and the appearance of aging dark circles. Selfies could be automatically graded and examined by artificial intelligence, which is a quick and private method for quantifying signs of facial aging and identifying major problems for different populations. Artificial intelligence would assist in the development of individualized preventive and therapeutic interventions.

Lip color measurement: A new hyperspectral imaging device

INTRODUCTION

The lips are of significant interest among the facial features for self-perception and social interactions. Such perceptions could rely in part upon the contrast in color between the lips and the surrounding skin. In contrast to skin color, lip color ethnic diversity measurement provides a challenge and is less documented in the literature, most likely due primarily to challenges in measurement based upon the lip characteristics of size and contour. Accurate measurement and reproduction of lip color are essential to build strong cross-sectional knowledge about lip color.

OBJECTIVE

This preliminary experiment of a large-scale project on lip and skin color was designed to assess accuracy in lip color measurement and recommend instruments and protocols for good measurement practice.

METHODS

The study involved 19 healthy French Caucasian women. Their inferior and superior natural lip color was measured twice with three devices in order to extract the standard colorimetric parameters of lightness (L*), chroma (C*), and hue (h): the VISIA-CR® (high-resolution digital camera, Canfield Scientific Inc.); the spectrophotometer VS3200 (45°:0° spectrophotometer, MetaVue™ VS3200, X-Rite Inc.); and the SpectraFace® (new hyperspectral imaging system, Newtone Technologies). The intercomparison and color distribution between the different instruments and the measurement repeatability of each one were assessed.

RESULTS

Our results showed a reliable and equivalent repeatability for the three tested instruments. Moreover, the three tools led to the same conclusion regarding lip color heterogeneity (lighter, redder, less yellow and more saturated inferior lip versus superior lip). Agreement between the SpectraFace® and the spectrophotometer measurements was higher, and the SpectraFace® allowed to identify three separated lip color typologies.

CONCLUSION

In conclusion, the combination of imaging technology and hyperspectral measurement makes the SpectraFace® a useful tool to investigate lip color characterization and establish a large-scale cross-sectional knowledge study about lip color.

TFOS Lifestyle: Impact of cosmetics on the ocular surface

In this report the use of eye cosmetic products and procedures and how this represents a lifestyle challenge that may exacerbate or promote the development of ocular surface and adnexal disease is discussed. Multiple aspects of eye cosmetics are addressed, including their history and market value, psychological and social impacts, possible problems associated with cosmetic ingredients, products, and procedures, and regulations for eye cosmetic use. In addition, a systematic review that critically appraises randomized controlled trial evidence concerning the ocular effects of eyelash growth products is included. The findings of this systematic review highlight the evidence gaps and indicate future directions for research to focus on ocular surface outcomes associated with eyelash growth products.

Where on the face do we look during phonemic restoration: An eye-tracking study

Face to face communication typically involves audio and visual components to the speech signal. To examine the effect of task demands on gaze patterns in response to a speaking face, adults participated in two eye-tracking experiments with an audiovisual (articulatory information from the mouth was visible) and a pixelated condition (articulatory information was not visible). Further, task demands were manipulated by having listeners respond in a passive (no response) or an active (button press response) context. The active experiment required participants to discriminate between speech stimuli and was designed to mimic environmental situations which require one to use visual information to disambiguate the speaker's message, simulating different listening conditions in real-world settings. Stimuli included a clear exemplar of the syllable /ba/ and a second exemplar in which the formant initial consonant was reduced creating an /a/-like consonant. Consistent with our hypothesis, results revealed that the greatest fixations to the mouth were present in the audiovisual active experiment and visual articulatory information led to a phonemic restoration effect for the /a/ speech token. In the pixelated condition, participants fixated on the eyes, and discrimination of the deviant token within the active experiment was significantly greater than the audiovisual condition. These results suggest that when required to disambiguate changes in speech, adults may look to the mouth for additional cues to support processing when it is available.

Impact of face masks and sunglasses on attractiveness, trustworthiness, and familiarity, and limited time effect: a Japanese sample

Many studies conducted after the COVID-19 pandemic have examined the relationship between changes in social traits, such as attractiveness and wearing face masks. However, most studies examine the effect of wearing face masks at a single time point, and the time effect is not known. Additionally, few studies address wearing sunglasses, another facial occluding item. This study examined the effects of facial occluding (unoccluded face, face masks, sunglasses, or both) on perceived attractiveness, trustworthiness, and familiarity at two time points, September 2020, six months after the start of the COVID-19 pandemic, and April 2022, almost two years later, using Japanese higher and lower attractive faces. Results showed that only lower attractive faces wearing face masks had a time effect on attractiveness and familiarity and no time effect on social traits in higher attractive faces. Perceived all social traits were the highest for unoccluded faces, and faces wearing face masks had the same level of attractiveness and familiarity as unoccluded faces. Perceived trustworthiness was higher for unoccluded faces, faces wearing face masks, sunglasses, and both sunglasses and face masks, respectively. Additionally, faces wearing both sunglasses and face masks had the lowest perceived all social traits. These findings suggest that the positive and time effects of wearing face masks are limited in Japan, suggesting a greater positive impact of unoccluded faces. They also suggest that the negative impact of wearing sunglasses is significant.

Unattractive faces are more attractive when the bottom-half is masked, an effect that reverses when the top-half is concealed

Facial attractiveness in humans signals an individual's genetic condition, underlying physiology and health status, serving as a cue to one's mate value. The practice of wearing face masks for prevention of transmission of airborne infections may disrupt one's ability to evaluate facial attractiveness, and with it, cues to an individual's health and genetic condition. The current research investigated the effect of face masks on the perception of face attractiveness. Across four studies, we tested if below- and above-average attractive full faces are equally affected by wearing facial masks. The results reveal that for young faces (Study 1) and old faces (Study 2) a facial mask increases the perceived attractiveness of relatively unattractive faces, but there is no effect of wearing a face mask for highly attractive faces. Study 3 shows that the same pattern of ratings emerged when the bottom-half of the faces are cropped rather than masked, indicating that the effect is not mask-specific. Our final Study 4, in which information from only the lower half of the faces was made available, showed that contrary to our previous findings, highly attractive half-faces are perceived to be less attractive than their full-face counterpart; but there is no such effect for the less attractive faces. This demonstrates the importance of the eye-region in the perception of attractiveness, especially for highly attractive faces. Collectively these findings suggest that a positivity-bias enhances the perception of unattractive faces when only the upper face is visible, a finding that may not extend to attractive faces because of the perceptual weight placed on their eye-region.

Developing an Artificial Intelligence (A.I)-based descriptor of facial appearance that fits with the assessments of makeup experts

OBJECTIVE

To develop an A.I-based automatic descriptor that detects and grades, from selfie pictures, 23 facial signs, hairs included, as a help to making-up procedures.

MATERIAL AND METHODS

The selfie images taken in very different conditions by 3326 women and men were used to create (90% of dataset) and validate (10% of dataset) a new algorithm architecture to appraise and grade 23 different facial signs such as lips, nose, eye color, eyebrows, eyelashes, and hair color as defined by makeup artists. Each selfie image was annotated by 12 experts and defined references to train Artificial Intelligence (A.I)-based algorithm.

RESULTS

As some the 23 signs present a continuous or discontinuous feature, these were analyzed by two different statistical approaches. The results provided by the automatic descriptor system were not only in good agreement with the expert's assessments but were even found of a better precision and reproducibility. This automatic descriptor system has proven a good and robust accuracy despite the very variable conditions in the acquisition of selfie pictures.

CONCLUSION

Such automatic descriptor system seems providing a valuable help in making-up procedures and may extend to other activities such as Skincare or Haircare. As such it should allow large investigations to better evaluate the consumers' needs of esthetical improvements.

Effects of laser therapy on periorbital hyperpigmentation: a systematic review on current studies

Periorbital hyperpigmentation is a problem with complex multifactorial etiology, with early knowledge expanding. The purpose of the present study was to review studies on the efficacy of laser on periorbital hyperpigmentation. A systematic review of the data banks of scientific and research articles including PubMed, Web of Knowledge, Google Scholar, SCOPUS, and Iranian databases including SID and Magiran is performed. The following keywords were used to evaluate existing articles: Periorbital Hyperpigmentation, Periorbital Darkening, Dark Eye Circle, Eye Dark Circle, Infraorbital Hyperpigmentation, Infraorbital Dark Circle, and Laser (1990-2018). Finally, 10 clinical trial articles were included. A total of 2.76% of patients responded poor, 11.4% responded fair to different types of lasers, 45.3% responded good, and 35.9% excellent responded to have been cured. As a long-term effect, less than 1% of patients received a poor score after their laser treatment. Twenty-five percent of the patients showed a fair result. In total, 26.27% of patients achieved good and 43.35% of patients received excellent response from laser treatment on periorbital hyperpigmentation after 4-6 months of laser therapy. A large percentage of patients (76.4%) were satisfied with the effect of lasers on the reduction of moderate to high periorbital hyperpigmentation rates in the studies. Laser therapy is an effective and satisfactory therapeutic choice for treatment of periorbital hyperpigmentation. Also, it is safe overall with favorable sustainable results, although the follow-up periods usually last about several months.

How does gaze to faces support face-to-face interaction? A review and perspective

Gaze-where one looks, how long, and when-plays an essential part in human social behavior. While many aspects of social gaze have been reviewed, there is no comprehensive review or theoretical framework that describes how gaze to faces supports face-to-face interaction. In this review, I address the following questions: (1) When does gaze need to be allocated to a particular region of a face in order to provide the relevant information for successful interaction; (2) How do humans look at other people, and faces in particular, regardless of whether gaze needs to be directed at a particular region to acquire the relevant visual information; (3) How does gaze support the regulation of interaction? The work reviewed spans psychophysical research, observational research, and eye-tracking research in both lab-based and interactive contexts. Based on the literature overview, I sketch a framework for future research based on dynamic systems theory. The framework holds that gaze should be investigated in relation to sub-states of the interaction, encompassing sub-states of the interactors, the content of the interaction as well as the interactive context. The relevant sub-states for understanding gaze in interaction vary over different timescales from microgenesis to ontogenesis and phylogenesis. The framework has important implications for vision science, psychopathology, developmental science, and social robotics.

Aesthetic outcomes of upper eyelid blepharoplasty: a systematic review

Although upper blepharoplasty is a common cosmetic surgical intervention, a better scientific understanding of the aesthetic results and the preferred surgical technique to achieve the best aesthetic results is still needed. A systematic search using four search engines (PubMed, Embase, CINAHL, and Cochrane) was performed to identify any study on the aesthetic outcome of a solitary upper blepharoplasty; these were subjected to quality assessment for possible inclusion. Eligible studies were randomized controlled trials, controlled trials, cohort studies, and case series (n ≥ 10). A total of 4043 studies were assessed, of which 26 were included. Aesthetic outcomes included patient-reported outcome measures, scarring, eyebrow height, tarsal platform show, and panel or expert evaluation. Meta-analysis was not possible. Patients were generally satisfied with the aesthetic result and scar formation after an upper blepharoplasty. The amount of tarsal platform show increases, which positively affects the aesthetics. The eyebrow seems to move down slightly. The surgical technique used (skin only or skin/muscle removal) did not influence patient satisfaction or the physician-assessed aesthetic outcomes. Patients are generally satisfied after an upper blepharoplasty. The optimal design of the skin excision is still a matter of debate, especially when addressing lateral hooding. Further objective research is advised.

Using principal component analysis to characterize eye movement fixation patterns during face viewing

Human faces contain dozens of visual features, but viewers preferentially fixate just two of them: the eyes and the mouth. Face-viewing behavior is usually studied by manually drawing regions of interest (ROIs) on the eyes, mouth, and other facial features. ROI analyses are problematic as they require arbitrary experimenter decisions about the location and number of ROIs, and they discard data because all fixations within each ROI are treated identically and fixations outside of any ROI are ignored. We introduce a data-driven method that uses principal component analysis (PCA) to characterize human face-viewing behavior. All fixations are entered into a PCA, and the resulting eigenimages provide a quantitative measure of variability in face-viewing behavior. In fixation data from 41 participants viewing four face exemplars under three stimulus and task conditions, the first principal component (PC1) separated the eye and mouth regions of the face. PC1 scores varied widely across participants, revealing large individual differences in preference for eye or mouth fixation, and PC1 scores varied by condition, revealing the importance of behavioral task in determining fixation location. Linear mixed effects modeling of the PC1 scores demonstrated that task condition accounted for 41% of the variance, individual differences accounted for 28% of the variance, and stimulus exemplar for less than 1% of the variance. Fixation eigenimages provide a useful tool for investigating the relative importance of the different factors that drive human face-viewing behavior.

Safety and Efficacy of a Trans-Eyelid Facial Rejuvenation Surgery Combining Partial Repositioning of Orbital Fat and Midface Lift in Chinese Patients: A Prospective Case Series

OBJECTIVE

To describe the combined technique of midface lift and partial release of orbital fat for facial rejuvenation and evaluate the safety and aesthetic results.

METHODS

This was a single-center study that included patients who underwent facial rejuvenation from January 2010 to December 2016. The orbital fat was partially removed, and the cheek fat pads were repositioned to exfoliate the myocutaneous flaps of the lower eyelids and midface through a sub-ciliary incision. The cheek soft tissue pads and orbital fat were restored and sutured to the periorbital membranes and orbital margins. Postoperatively, the patients were examined at 6 and 18 months for changes in the shapes of cheeks, eyelid joints, sunken eyepit, and nasolabial sulcus along with procedural complications.

RESULTS

A total of 179 (177 women; 2 men) eligible patients with a mean age of 47.17 years underwent the procedure. The shapes of cheeks and eyelid joints of all patients improved, along with shallowing of the sunken eyepit and nasolabial sulcus at 6- and 18-month follow-up. The surgical procedure involved minor trauma without facial scarring, lower eyelid flinch, and dislocation. None of the patients reported complications of nerve injuries, long-term chemosis conjunctiva, periocular swelling, or dislocation of the lower eyelids. Only 2 patients who underwent subsequent pouch surgeries had slight ectropion, which was restored within 4 months of surgery.

CONCLUSION

To conclude, the combined partial orbital fat repositioning and midface lift via sub-ciliary approach is a successful treatment option for facial rejuvenation with no major complications.

Does it look safe? An eye tracking study into the visual aspects of fear of crime

Studies of fear of crime often focus on demographic and social factors, but these can be difficult to change. Studies of visual aspects have suggested that features reflecting incivilities, such as litter, graffiti, and vandalism increase fear of crime, but methods often rely on participants actively mentioning such aspects, and more subtle, less conscious aspects may be overlooked. To address these concerns, this study examined people’s eye movements while they judged scenes for safety. In total, 40 current and former university students were asked to rate images of day-time and night-time scenes of Lincoln, UK (where they studied) and Egham, UK (unfamiliar location) for safety, maintenance, and familiarity while their eye movements were recorded. Another 25 observers not from Lincoln or Egham rated the same images in an Internet survey. Ratings showed a strong association between safety and maintenance and lower safety ratings for night-time scenes for both groups, in agreement with earlier findings. Eye movements of the Lincoln participants showed increased dwell times on buildings, houses, and vehicles during safety judgements and increased dwell times on streets, pavements, and markers of incivilities for maintenance. Results confirm that maintenance plays an important role in perceptions of safety, but eye movements suggest that observers also look for indicators of current or recent presence of people.

A new procedure, free from human assessment that automatically grades some facial skin structural signs. Comparison with assessments by experts, using referential atlases of skin ageing

OBJECTIVE

To develop an automatic system that grades the severity of facial signs through 'selfies' pictures taken by women of different ages and ethnics.

METHODS

1140 women from three ethnics (African-American, Asian, Caucasian), of different ages (18-80 years old), took 'selfies' by high resolution smartphones cameras under different conditions of lighting or facial expressions. A dedicated software, was developed, based on a Convolutional Neural Network (CNN) that integrates training data from referential Skin Aging Atlases. The latter allows to an immediate quantification of the severity of nine facial signs according to the ethnicity declared by the subject. These automatic grading were confronted to those assessed by 12 trained experts and dermatologists either on 'selfies' pictures or in live conditions on a smaller cohort of women.

RESULTS

The system appears weakly influenced by lighting conditions or facial expressions (coefficients of variations ranging 10-13% for most signs) and leads to global agreements with experts' assessments, even showing a better reproducibility on some facial signs.

CONCLUSION

This automatic scoring system, still in development, seems offering a new quantitative approach in the quantified description of facial signs, independent from human vision, in many applications, being individual, cosmetic oriented or dermatological with regard to the follow-up of medical anti-ageing corrective strategies.

Eye movements while judging faces for trustworthiness and dominance

Past studies examining how people judge faces for trustworthiness and dominance have suggested that they use particular facial features (e.g. mouth features for trustworthiness, eyebrow and cheek features for dominance ratings) to complete the task. Here, we examine whether eye movements during the task reflect the importance of these features. We here compared eye movements for trustworthiness and dominance ratings of face images under three stimulus configurations: Small images (mimicking large viewing distances), large images (mimicking face to face viewing), and a moving window condition (removing extrafoveal information). Whereas first area fixated, dwell times, and number of fixations depended on the size of the stimuli and the availability of extrafoveal vision, and varied substantially across participants, no clear task differences were found. These results indicate that gaze patterns for face stimuli are highly individual, do not vary between trustworthiness and dominance ratings, but are influenced by the size of the stimuli and the availability of extrafoveal vision.

A Dual Approach to Understanding Facial Perception Before and After Blepharoplasty

Importance

Blepharoplasty consistently ranks among the most common facial plastic surgery procedure sought by both men and women. Despite the popularity of blepharoplasty, there has been little research focused on quantifying how eyelid surgery changes facial perceptions.

Objectives

To quantify the effect of blepharoplasty on facial perceptions and measure patient-reported ratings of fatigue before and after surgery to compare observer and patient perceptions.

Design, Setting, and Participants

A web-based survey experiment was conducted from January to February 2017, featuring photographs of female patients before and after blepharoplasty. Observers were randomly shown independent images of each patient and asked to rate perceived age, attractiveness, health, and energy level. Respondents saw only preoperative or postoperative photographs of each patient to reduce bias due to priming. Patient-reported outcomes were also collected.

Main Outcomes and Measures

A multivariate mixed effects regression model was used to quantify the changes in each domain after surgery. Ordinal rank change was calculated to provide a measure of clinical effect size across the domains. To analyze patient-reported outcomes, a Kruskal-Wallis test followed by Mann-Whitney tests were performed to determine if there were differences in patient-perceived tiredness based on operative status.

Results

A total of 401 participants (243 women, 152 men, and 6 not specified; mean age 25.9 years [range, 18-73 years]) successfully completed the survey and evaluated before-and-after photographs of 10 female patients (mean age, 59.8 years). The multivariable mixed effects model revealed that individuals are perceived as appearing significantly younger (-1.04 years; 95% CI, -1.70 to -0.37 years) and more attractive (coefficient, 4.92; 95% CI, 3.91-5.93) after blepharoplasty. Ratings of perceived health (coefficient, 4.33; 95% CI, 3.28-5.37) and energy level (coefficient, 9.83; 95% CI, 8.51-11.16) also improved significantly. After undergoing blepharoplasty, patients had significantly improved ratings of energy level compared with those who had not undergone blepharoplasty.

Conclusions and Relevance

This is the first study, to date, aimed at quantifying the perceptions of facial aesthetic changes following blepharoplasty. The data demonstrate that individuals are rated as appearing more youthful, attractive, and healthy following blepharoplasty. Furthermore, both patients and casual observers perceived a significant improvement in energy level following blepharoplasty, a meaningful finding as the appearance of fatigue is a chief concern of the patients before they undergo blepharoplasty.

Level of Evidence

NA.

Patterns of Eye Movements When Observers Judge Female Facial Attractiveness

The purpose of the present study is to explore the fixed model for the explicit judgments of attractiveness and infer which features are important to judge the facial attractiveness. Behavioral studies on the perceptual cues for female facial attractiveness implied three potentially important features: averageness, symmetry, and sexual dimorphy. However, these studies did not explained which regions of facial images influence the judgments of attractiveness. Therefore, the present research recorded the eye movements of 24 male participants and 19 female participants as they rated a series of 30 photographs of female facial attractiveness. Results demonstrated the following: (1) Fixation is longer and more frequent on the noses of female faces than on their eyes and mouths (no difference exists between the eyes and the mouth); (2) The average pupil diameter at the nose region is bigger than that at the eyes and mouth (no difference exists between the eyes and the mouth); (3) the number of fixations of male participants was significantly more than female participants. (4) Observers first fixate on the eyes and mouth (no difference exists between the eyes and the mouth) before fixating on the nose area. In general, participants attend predominantly to the nose to form attractiveness judgments. The results of this study add a new dimension to the existing literature on judgment of facial attractiveness. The major contribution of the present study is the finding that the area of the nose is vital in the judgment of facial attractiveness. This finding establish a contribution of partial processing on female facial attractiveness judgments during eye-tracking.

Altered Perception of Facially Expressed Tiredness in Insomnia

The present study compared normal sleepers and individuals displaying insomnia symptoms in their ratings for the expression intensity of tiredness and alertness whilst observing tired and neutral faces. Fifty-six normal sleepers and 58 individuals with insomnia symptoms observed 98 facial photographs (49 neutral, 49 tired). Using a visual analogue scale, participants were required to rate the extent to which each face appeared as tired and alert. Tired faces were created by manipulating neutral photographs to include previously identified facial tiredness cues. All participants rated sleep-related faces as more tired and less alert relative to neutral photographs. A significant Group × Face × Rating interaction demonstrated that, compared with normal sleepers, the insomnia symptoms group showed lower ratings for the expression of tiredness, but not alertness, whilst observing the tired faces. The findings suggest that the presence of insomnia symptoms is associated with reduced ratings of expression intensity for sleep-related facial photographs displaying tiredness. These outcomes add to the body of literature on how facial cues of tiredness are perceived by those with insomnia symptoms. Further work is required to elucidate the mechanisms underlying the relationship between insomnia symptoms and reduced perceptions of facially expressed tiredness.

The impact of facial abnormalities and their spatial position on perception of cuteness and attractiveness of infant faces

Research has demonstrated that how “cute” an infant is perceived to be has consequences for caregiving. Infants with facial abnormalities receive lower ratings of cuteness, but relatively little is known about how different abnormalities and their location affect these aesthetic judgements. The objective of the current study was to compare the impact of different abnormalities on the perception of infant faces, while controlling for infant identity. In two experiments, adult participants gave ratings of cuteness and attractiveness in response to face images that had been edited to introduce common facial abnormalities. Stimulus faces displayed either a haemangioma (a small, benign birth mark), strabismus (an abnormal alignment of the eyes) or a cleft lip (an abnormal opening in the upper lip). In Experiment 1, haemangioma had less of a detrimental effect on ratings than the more severe abnormalities. In Experiment 2, we manipulated the position of a haemangioma on the face. We found small but robust effects of this position, with abnormalities in the top and on the left of the face receiving lower cuteness ratings. This is consistent with previous research showing that people attend more to the top of the face (particularly the eyes) and to the left hemifield.

Technical Considerations for Filler and Neuromodulator Refinements

Supplemental Digital Content is available in the text.

Background: The toolbox for cosmetic practitioners is growing at an unprecedented rate. There are novel products every year and expanding off-label indications for neurotoxin and soft-tissue filler applications. Consequently, aesthetic physicians are increasingly challenged by the task of selecting the most appropriate products and techniques to achieve optimal patient outcomes.

Methods: We employed a PubMed literature search of facial injectables from the past 10 years (2005–2015), with emphasis on those articles embracing evidence-based medicine. We evaluated the scientific background of every product and the physicochemical properties that make each one ideal for specific indications. The 2 senior authors provide commentary regarding their clinical experience with specific technical refinements of neuromodulators and soft-tissue fillers.

Results: Neurotoxins and fillers are characterized by unique physical characteristics that distinguish each product. This results in subtle but important differences in their clinical applications. Specific indications and recommendations for the use of the various neurotoxins and soft-tissue fillers are reviewed. The discussion highlights refinements in combination treatments and product physical modifications, according to specific treatment zones.

Conclusions: The field of facial aesthetics has evolved dramatically, mostly secondary to our increased understanding of 3-dimensional structural volume restoration. Our work reviews Food and Drug Administration–approved injectables. In addition, we describe how to modify products to fulfill specific indications such as treatment of the mid face, décolletage, hands, and periorbital regions. Although we cannot directly evaluate the duration or exact physical properties of blended products, we argue that “product customization” is safe and provides natural results with excellent patient outcomes.

The area-of-interest problem in eyetracking research: A noise-robust solution for face and sparse stimuli

A problem in eyetracking research is choosing areas of interest (AOIs): Researchers in the same field often use widely varying AOIs for similar stimuli, making cross-study comparisons difficult or even impossible. Subjective choices while choosing AOIs cause differences in AOI shape, size, and location. On the other hand, not many guidelines for constructing AOIs, or comparisons between AOI-production methods, are available. In the present study, we addressed this gap by comparing AOI-production methods in face stimuli, using data collected with infants and adults (with autism spectrum disorder [ASD] and matched controls). Specifically, we report that the attention-attracting and attention-maintaining capacities of AOIs differ between AOI-production methods, and that this matters for statistical comparisons in one of three groups investigated (the ASD group). In addition, we investigated the relation between AOI size and an AOI's attention-attracting and attention-maintaining capacities, as well as the consequences for statistical analyses, and report that adopting large AOIs solves the problem of statistical differences between the AOI methods. Finally, we tested AOI-production methods for their robustness to noise, and report that large AOIs-using the Voronoi tessellation method or the limited-radius Voronoi tessellation method with large radii-are most robust to noise. We conclude that large AOIs are a noise-robust solution in face stimuli and, when implemented using the Voronoi method, are the most objective of the researcher-defined AOIs. Adopting Voronoi AOIs in face-scanning research should allow better between-group and cross-study comparisons.

Preferential attention towards the eye-region amongst individuals with insomnia

People with insomnia often perceive their own facial appearance as more tired compared with the appearance of others. Evidence also highlights the eye-region in projecting tiredness cues to perceivers, and tiredness judgements often rely on preferential attention towards this region. Using a novel eye-tracking paradigm, this study examined: (i) whether individuals with insomnia display preferential attention towards the eye-region, relative to nose and mouth regions, whilst observing faces compared with normal-sleepers; and (ii) whether an attentional bias towards the eye-region amongst individuals with insomnia is self-specific or general in nature. Twenty individuals with DSM-5 Insomnia Disorder and 20 normal-sleepers viewed 48 neutral facial photographs (24 of themselves, 24 of other people) for periods of 4000 ms. Eye movements were recorded using eye-tracking, and first fixation onset, first fixation duration and total gaze duration were examined for three interest-regions (eyes, nose, mouth). Significant group × interest-region interactions indicated that, regardless of the face presented, participants with insomnia were quicker to attend to, and spent more time observing, the eye-region relative to the nose and mouth regions compared with normal-sleepers. However, no group × face × interest-region interactions were established. Thus, whilst individuals with insomnia displayed preferential attention towards the eye-region in general, this effect was not accentuated during self-perception. Insomnia appears to be characterized by a general, rather than self-specific, attentional bias towards the eye-region. These findings contribute to our understanding of face perception in insomnia, and provide tentative support for cognitive models of insomnia demonstrating that individuals with insomnia monitor faces in general, with a specific focus around the eye-region, for cues associated with tiredness.

Infraorbital Dark Circles: A Review of the Pathogenesis, Evaluation and Treatment

Infraorbital dark circles represent a common and multifactorial challenge in the world of aesthetic medicine and are the result of a variety of factors including deep facial anatomy, soft tissue changes, as well as contributions from the skin. A variety of treatment options exist, and a customised management strategy can be developed for the particular anatomic changes present. A literature search using MEDLINE and non-MEDLINE sources was performed utilising keywords including: ‘Dark circles’ ‘infraorbital dark circles’, ‘infraorbital pigment’, ‘under-eye circles’ and ‘lower eyelid bags’. A comprehensive review of the literature was performed and the data were assimilated with evidence from our practice. This review provides a detailed discussion of the aetiology, pathogenesis, evaluation and management of infraorbital dark circles. An understanding of the deep and superficial anatomy is crucial to the management of this complex entity. The armamentarium for treatment includes minimally invasive interventions such as makeup and cosmeceuticals, a variety of laser and chemical treatments, fillers and fat transfer, as well as more invasive surgical manoeuvres.

Face recognition in schizophrenia disorder: A comprehensive review of behavioral, neuroimaging and neurophysiological studies

Facial emotion processing has been extensively studied in schizophrenia patients while general face processing has received less attention. The already published reviews do not address the current scientific literature in a complete manner. Therefore, here we tried to answer some questions that remain to be clarified, particularly: are the non-emotional aspects of facial processing in fact impaired in schizophrenia patients? At the behavioral level, our key conclusions are that visual perception deficit in schizophrenia patients: are not specific to faces; are most often present when the cognitive (e.g. attention) and perceptual demands of the tasks are important; and seems to worsen with the illness chronification. Although, currently evidence suggests impaired second order configural processing, more studies are necessary to determine whether or not holistic processing is impaired in schizophrenia patients. Neural and neurophysiological evidence suggests impaired earlier levels of visual processing, which might involve the deficits in interaction of the magnocellular and parvocellular pathways impacting on further processing. These deficits seem to be present even before the disorder out-set. Although evidence suggests that this deficit may be not specific to faces, further evidence on this question is necessary, in particularly more ecological studies including context and body processing.

Humans have idiosyncratic and task-specific scanpaths for judging faces

Since Yarbus's seminal work, vision scientists have argued that our eye movement patterns differ depending upon our task. This has recently motivated the creation of multi-fixation pattern analysis algorithms that try to infer a person's task (or mental state) from their eye movements alone. Here, we introduce new algorithms for multi-fixation pattern analysis, and we use them to argue that people have scanpath routines for judging faces. We tested our methods on the eye movements of subjects as they made six distinct judgments about faces. We found that our algorithms could detect whether a participant is trying to distinguish angriness, happiness, trustworthiness, tiredness, attractiveness, or age. However, our algorithms were more accurate at inferring a subject's task when only trained on data from that subject than when trained on data gathered from other subjects, and we were able to infer the identity of our subjects using the same algorithms. These results suggest that (1) individuals have scanpath routines for judging faces, and that (2) these are diagnostic of that subject, but that (3) at least for the tasks we used, subjects do not converge on the same "ideal" scanpath pattern. Whether universal scanpath patterns exist for a task, we suggest, depends on the task's constraints and the level of expertise of the subject.

Evaluation of surgical outcomes for ptosis surgery by face recognition software

PURPOSE

This study was aimed to use the age estimation segment of face recognition software to determine whether patients appeared younger after surgery for aponeurotic ptosis and dermatochalasis.

DESIGN

This is a prospective interventional case series.

METHODS

Face recognition software was used to estimate the age of 12 Japanese patients who had surgery to repair aponeurotic ptosis or dermatochalasis. Photographs of the faces before and 1 month after the surgery were taken and uploaded to the face recognition software to estimate the age of the subjects.

RESULTS

The preoperative estimated age significantly correlated with the actual age (r = 0.647, P = 0.023), and the postoperative estimated age also significantly correlated with the actual age (r = 0.727, P = 0.007). The scores of the palpebral fissure width of the right eyes (P = 0.003) and left eyes (P = 0.002) significantly improved postoperatively. However, the postoperative estimated age was not significantly younger than the preoperative estimated age (P = 0.173).

CONCLUSIONS

The face recognition software may not be influenced by the lid plastic surgery. Many factors other than the width of the palpebral fissure influence the estimation of age by the face recognition software.

Novel use of polymethyl methacrylate (PMMA) microspheres in the treatment of infraorbital rhytids

AIM

To demonstrate safely with the use of polymethyl methacrylate (PMMA) microspheres in the infraorbital eyelid area using a deliberate conservative injection in the treatment of rhytids.

METHODS

A retrospective case series of 289 patients in an outpatient cosmetic dermatology clinic evaluated and treated by one senior provider (NM) of infraorbital rhytids with PMMA from December 2010 to March 2011. Statistical analysis was performed for race, skin type, history of hypertrophic scar, autoimmunity, history of "sensitive skin" and history of prior procedures such as prior facelift, rhinoplasty, and blepharoplasty.

RESULTS

Two hundred ninety-one patients underwent at least 1-6 injections of PMMA microspheres into bilateral under eye area. Early complications were edema and ecchymosis. Late complications were identified in 4 of 289 patients who developed small granulomas. All patients who developed granulomas had had a previous lower blepharoplasty (P = 0.00). A history of "sensitive skin" was approaching statistical significance (P = 0.15).

CONCLUSION

This study has shown that PMMA microsphere injection is a safe subdermal technique in the correction of infraorbital rhytids. Safety was demonstrated in 289 patients with only 4 minor complications of small lateral granuloma which all resolved within 4 weeks after intralesion triamcinolone injection. However, this is an off-label use of a permanent filler not approved for use in the infraorbits and significant caution must be taken with full disclosure to the patient leading to informed consent. Caution in PMMA microsphere injection should be given in the patient with prior blepharoplasty. The advantage of PMMA microsphere is that the result seems to be predictable and natural.

Cues of fatigue: effects of sleep deprivation on facial appearance

STUDY OBJECTIVE

To investigate the facial cues by which one recognizes that someone is sleep deprived versus not sleep deprived.

DESIGN

Experimental laboratory study.

SETTING

Karolinska Institutet, Stockholm, Sweden.

PARTICIPANTS

Forty observers (20 women, mean age 25 ± 5 y) rated 20 facial photographs with respect to fatigue, 10 facial cues, and sadness. The stimulus material consisted of 10 individuals (five women) photographed at 14:30 after normal sleep and after 31 h of sleep deprivation following a night with 5 h of sleep.

MEASUREMENTS

Ratings of fatigue, fatigue-related cues, and sadness in facial photographs.

RESULTS

The faces of sleep deprived individuals were perceived as having more hanging eyelids, redder eyes, more swollen eyes, darker circles under the eyes, paler skin, more wrinkles/fine lines, and more droopy corners of the mouth (effects ranging from b = +3 ± 1 to b = +15 ± 1 mm on 100-mm visual analog scales, P < 0.01). The ratings of fatigue were related to glazed eyes and to all the cues affected by sleep deprivation (P < 0.01). Ratings of rash/eczema or tense lips were not significantly affected by sleep deprivation, nor associated with judgements of fatigue. In addition, sleep-deprived individuals looked sadder than after normal sleep, and sadness was related to looking fatigued (P < 0.01).

CONCLUSIONS

The results show that sleep deprivation affects features relating to the eyes, mouth, and skin, and that these features function as cues of sleep loss to other people. Because these facial regions are important in the communication between humans, facial cues of sleep deprivation and fatigue may carry social consequences for the sleep deprived individual in everyday life.

Visual exploration and action processing in schizophrenia

INTRODUCTION

Visual scanning is widely reported to be abnormal in schizophrenia. The majority of eye movement studies in schizophrenic patients have used pictures of a face in isolation in free viewings. This study was designed to examine whether attentional control, through instructions, modulates the visuomotor behaviour in schizophrenia with pictures presenting a face accompanied by its body, and to investigate the ability of schizophrenic patients to recognise others' actions.

METHOD

Visual scan paths were monitored in 26 schizophrenic patients and 26 controls. Participants performed three tasks in which they were asked either to look at the picture in any way they liked, to determine the character's gender, or to recognise the action that the character was making with an object.

RESULTS

Patients explored less the pictures than controls in the free viewing. Their scan paths did not differ from that of controls in the active viewings, though patients tended to "avoid" looking at the character's face in the action recognition task.

CONCLUSION

The results show that patients are able to normalise their pattern of exploration as a function of task demands. The results are discussed in relation to attentional control, cognitive flexibility, dopamine, and processing of context information.

Age and beauty are in the eye of the beholder

How "old" and "attractive" an individual appears has increasingly become an individual concern leading to the utilisation of various cosmetic surgical procedures aimed at enhancing appearance. Using eyetracking, in the present study we aimed to investigate how individuals perceive age and attractiveness of younger and older faces and what "bottom-up" facial cues are used in this process. One hundred and twenty eight digital images of neutral faces of ages ranging from 20 to 89 years were paired and presented to subjects who judged age and attractiveness levels while having their eye movements recorded. There was an effect of face attractiveness on age-rating accuracy, with attractive faces being rated younger than their true age. Similarly, stimulus age affected attractiveness ratings, with younger faces being perceived as more attractive. Judgments of age and attractiveness were tightly linked to fixations on the eye region, along with the nose and mouth. It is thus likely that cosmetic surgical procedures targeted at the eyes, nose, and mouth may be most efficacious at enhancing one's physical appearance.

A pilot study on using eye tracking to understand assessment of surgical outcomes from clinical photography

Appearance changes resulting from breast cancer treatment impact the quality of life of breast cancer survivors, but current approaches to evaluating breast characteristics are very limited. It is challenging, even for experienced plastic surgeons, to describe how different aspects of breast morphology impact overall assessment of esthetics. Moreover, it is difficult to describe what they are looking for in a manner that facilitates quantification. The goal of this study is to assess the potential of using eye-tracking technology to understand how plastic surgeons assess breast morphology by recording their gaze path while they rate physical characteristics of the breasts, e.g., symmetry, based on clinical photographs. In this study, dwell time, transition frequency, dwell sequence conditional probabilities, and dwell sequence joint probabilities were analyzed across photographic poses and three observers. Dwell-time analysis showed that all three surgeons spent the majority of their time on the anterior-posterior (AP) views. Similarly, transition frequency analysis between regions showed that there were substantially more transitions between the breast regions in the AP view, relative to the number of transitions between other views. The results of both the conditional and joint probability analyses between the breast regions showed that the highest probabilities of transitions were observed between the breast regions in the AP view (APRB, APLB) followed by the oblique views and the lateral views to complete evaluation of breast surgical outcomes.

Visible changes of female facial skin surface topography in relation to age and attractiveness perception

OBJECTIVES

Evolutionary psychology suggests that a woman's age and physical appearance are important mate choice criteria. Given that changes in female facial skin surface topography are important, prominent visible signs of aging, male perceptual sensitivity for variation in this trait may also affect preference and attractiveness judgment.

METHODS

Two experiments were conducted to investigate perception (Experiment 1) and noticeability (Experiment 2) of skin surface topography manipulations in facial images of six British women, aged 45-65 years. In Experiment 1 skin surface topography cues were completely removed on the cheeks, the "crow's feet" area adjacent to the eye, under the eyes, above the upper lip, and on the forehead while, in Experiment 2, it was removed gradually (20% increments) on the forehead and around the eyes. In both experiments, stimuli were presented to American and German participants (total N = 300, aged 15-55 years) in omnibus pair-wise combinations (within-face). With each pair, respondents were asked to select that face which they considered as younger looking (Experiments 1 and 2) and more attractive (Experiment 1).

RESULTS

Faces with skin surface topography cues removed were judged significantly younger and more attractive than their original (unmodified) counterparts, with modifications on the forehead and around the eyes showing the highest differences. In these areas, participants were able to detect at least a 20% visual change in skin surface topography.

CONCLUSIONS

The results support the assertion that even small changes in skin surface topography affect the perceptions of a woman's facial age and attractiveness and may, thus, also influence men's mate preferences.

Gaze control during face exploration in schizophrenia

Patients with schizophrenia perform worse than controls on various face perception tasks. Studies monitoring eye movements have shown reduced scan paths and a lower number of fixations to relevant facial features (eyes, nose, mouth) than to other parts. We examine whether attentional control, through instructions, modulates visual scanning in schizophrenia. Visual scan paths were monitored in 20 patients with schizophrenia and 20 controls. Participants started with a "free viewing" task followed by tasks in which they were asked to determine the gender, identify the facial expression, estimate the age, or decide whether the face was known or unknown. Temporal and spatial characteristics of scan paths were compared for each group and task. Consistent with the literature, patients with schizophrenia showed reduced attention to salient facial features in the passive viewing. However, their scan paths did not differ from that of controls when asked to determine the facial expression, the gender, the age or the familiarity of the face. The results are interpreted in terms of attentional control and cognitive flexibility.