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Losorelli S, Chang JK, Chang KW, Most SP, Truong MT. Gaze Patterns of Normal and Microtia Ears Pre- and Post-Reconstruction. Laryngoscope 2024; 134:3136-3142. [PMID: 38334225 DOI: 10.1002/lary.31331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 01/17/2024] [Accepted: 01/23/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVES To understand attentional preferences for normal and microtia ears. METHODS Eye-tracking technology was used to characterize gaze preferences. A total of 71 participants viewed images of 5 patients with unilateral microtia. Profile images of patient faces and isolated ears including normal, microtia, and post-reconstruction microtia ears were shown. Total time of fixation in predefined areas of interest (AOI) was measured. Inferential statistics were used to assess significance of fixation differences between AOIs within and between facial or auricular features. RESULTS The ear received most visual attention in lateral view of the face (1.91 s, 1.66-2.16 s) [mean, 95% CI], followed by features of the "central triangle"-the eyes (1.26 s, 1.06-1.46), nose (0.48 s, 0.38-0.58), and mouth (0.15 s, 0.15-0.20). In frontal view, microtia ears received less attention following surgical reconstruction (0.74 s vs. 0.4 s, p < 0.001). The concha was the most attended feature for both normal (2.97 s, 2.7-3.23) and reconstructed microtia ears (1.87 s, 1.61-2.13). Scars on reconstructed ears altered the typical visual scanpath. CONCLUSION The ear is an attentional gaze landmark of the face. Attention to microtia ears, both pre- and post-reconstruction, differs from gaze patterns of normal ears. The concha was the most attended to subunit of the ear. Attentional gaze may provide an unbiased method to determine what is important in reconstructive surgery. LEVEL OF EVIDENCE NA Laryngoscope, 134:3136-3142, 2024.
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Affiliation(s)
- Steven Losorelli
- Department of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Julia K Chang
- California University of Science and Medicine, Colton, California, U.S.A
| | - Kay W Chang
- Department of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Sam P Most
- Department of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Mai Thy Truong
- Department of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
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Fearington FW, Pumford AD, Awadallah AS, Dey JK. Searching for Signs of Plastic Surgery on the Face: Tracking the Eyes of Where Observers Look. Facial Plast Surg Aesthet Med 2024. [PMID: 38530096 DOI: 10.1089/fpsam.2023.0260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024] Open
Abstract
Background: Objective measurement of where observers direct their attention to faces when searching for signs of facial plastic surgery (FPS) is currently lacking. Objective: To compare where laypersons direct their attention on facial photographs using eye-tracking software when they are asked to (1) search for signs of aesthetic facial surgery or (2) allowed to gaze without direction (free-gaze). Methods: Naïve observers either free-gazed or examined faces for signs of FPS (FPS-prompted) for 10 s per face while their gaze was recorded by an eye-tracking system. Faces had no known history or signs/stigmata of FPS and were selected from the FACES and CFD databases with a diverse demographic distribution. Gaze times in nine facial subregions were analyzed using mixed-effects linear regression. Results: In FPS-prompted observers (n = 50, mean age 32.7 ± 11.3 years, 23/50 (46%) female), the nose, mouth, cheeks, and forehead experienced the most substantial increases (p < 0.001) and a high percentage of overall gaze time (17.9%, 12.5%, 12.0%, 9.6%, respectively) compared to free-gazing observers [n = 57, 35.5 ± 13.9 years, 31/57 (54%) female]. Conclusions: Observers direct attention differently on a face when searching for signs of plastic surgery with increased attention on the nose, mouth, cheeks, and forehead.
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Affiliation(s)
| | - Andrew D Pumford
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Andrew S Awadallah
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jacob K Dey
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Atiyeh B, Emsieh S, Hakim C, Chalhoub R, Habal M. A Narrative Review of Eye-Tracking Assessment of Esthetic Endpoints in Plastic, Reconstructive, and Craniofacial Surgery. J Craniofac Surg 2023; 34:2137-2141. [PMID: 37590000 DOI: 10.1097/scs.0000000000009578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 05/31/2023] [Indexed: 08/18/2023] Open
Abstract
ABSTRACT Reporting of esthetic outcomes in plastic surgery relies classically on ill-defined endpoints and subjective measures very often from the patients' and/or providers' perspectives that are notoriously characterized by subjectivity and questionable solid scientific validation. With the recent trend of increasing demand for all types of esthetic medical and surgical interventions, there is an urgent need for reliable and objective outcome measures to quantitate esthetic outcomes and determine the efficacy of these interventions. The current review is intended to analyze available evidence regarding advantages as well as limitations of eye-tracking (ET) technology in objectively documenting esthetic outcomes of plastic, reconstructive, and craniofacial interventions. Although gaze pattern analysis is gaining more attention, ET data should be interpreted with caution; how a specific visual stimulus directly influences one's sense of esthetics is still not clear. Furthermore, despite its great potentials, it is still too early to confirm or deny ET usefulness. Nevertheless, patient-reported outcomes being most indicative of an esthetic intervention success, measurement of patients' satisfaction by ET technology could offer a major breakthrough in objective assessment of esthetic outcomes that need further in-depth investigation. EVIDENCE LEVEL Level III.
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Affiliation(s)
- Bishara Atiyeh
- American University of Beirut Medical Center, Beirut, Lebanon
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Boonipat T, Hebel NSD, Shapiro D, Stotland MA. Impact of Surgical Rejuvenation on Visual Processing and Character Attribution of Faces. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5038. [PMID: 37731729 PMCID: PMC10508498 DOI: 10.1097/gox.0000000000005038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 02/09/2023] [Indexed: 09/22/2023]
Abstract
Background This study considers observers' reflexive responses to the rejuvenated face, and how instinctive responses relate to subjective judgment. We investigated observers' reflexive perception of faces both pre and post surgical intervention during the early stages of visual processing. Subjective character attribution for all test images was also assessed by the same observers. Method Forty frontal facial images of 20 patients portraying the pre- and postoperative high superficial musculoaponeurotic system facelift along with variable concomitant procedures were studied. Nineteen lookzone regions were mapped post hoc onto each image. Forty observers examined the images, whereas an eye-tracking camera recorded their eye movements. Visual fixation data were recorded and analyzed. Observers also rated each image on the basis of five elemental positive character attributes. Results A statistically coherent but nonsignificant (P > 0.05) trend was identified with the surgical intervention resulting in greater attention being paid to the central triangle region of the face with reduction in attention to the facial periphery. Facial rejuvenation significantly increased the subjective character ratings of all five positively valenced attributes tested. Average age estimate of the photos decreased significantly from 54 to 48.6 years (true average age of 57.4 years). Conclusions We provide data illustrating both reflexive and subjective responses to facial rejuvenation. Observers reported a more favorable impression of the treated faces and evaluated them as being younger than their true age. A trend was detected for increased visual fixation of the central facial region following rejuvenation. Interpretation of these findings and indication for further research is provided.
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Affiliation(s)
- Thanapoom Boonipat
- From the Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minn
| | | | - Daniel Shapiro
- From the Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minn
| | - Mitchell A. Stotland
- Department of Surgery, Weill-Cornell Medical College- Doha, Qatar
- Division of Plastic, Craniofacial, and Hand Surgery, Sidra Medicine, Doha, Qatar
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Prahm C, Konieczny J, Bressler M, Heinzel J, Daigeler A, Kolbenschlag J, Lauer H. Influence of colored face masks on judgments of facial attractiveness and gaze patterns. Acta Psychol (Amst) 2023; 239:103994. [PMID: 37541135 DOI: 10.1016/j.actpsy.2023.103994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 07/27/2023] [Accepted: 07/28/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND Facial aesthetics are of great importance in social interaction. With the widespread adoption of face masks in response to the Covid-19 pandemic, there is growing interest in understanding how wearing masks might impact perceptions of attractiveness, as they partially or completely conceal facial features that are typically associated with attractiveness. OBJECTIVES This study aimed to explore the impact of mask wearing on attractiveness and to investigate whether the color (red or blue) of the mask has any effect on the perception of a person's attractiveness, while also considering gender and age as contributing factors. Additionally, the study intended to evaluate gaze patterns, initial focus, and dwell time in response to masked and unmasked faces. METHODS 30 AI-generated images of 15 female and 15 male faces were presented to 71 participants (35 male, 36 female) in 3 conditions: not wearing any mask, wearing a red surgical mask, and wearing a blue surgical mask. The perceived attractiveness was rated on an ordinal scale of 1-10 (10 being most attractive). Gaze behavior, dwell time and initial focus were recorded using a stationary eye-tracking system. RESULTS The study found that wearing masks had no significant effect on the attractiveness ratings of female faces (p = .084), but it did benefit the perceived attractiveness of male faces which were initially rated lower (p = .16). Gender and age also played a significant role, as both male and female participants rated female stimuli higher than male stimuli (p < .001), and younger participants rated both genders as less attractive than older participants (p < .01). However, there was no significant influence of the mask's color on attractiveness. During the eye-tracking analysis, the periorbital region was of greater interest while masked, with the time to first fixation for the eyes being lower than the non-masked stimulus (p < .001) and showed a longer dwell time (p < .001). The lower face was shown less interest while masked as the time to first fixation was higher (p < .001) and the fixation count was less (p < .001). Mask color did not influence the scan path and there was no difference in revisits to the mask area between red or blue masks (p = .202), nor was there a difference in time to first fixation (p = .660). CONCLUSIONS The study findings indicate that there is an interplay between the gender and age of the participant and the facial stimuli. The color red did have an effect on the perception attractiveness, however not in female faces. The results suggest that masks, especially red ones, might be more beneficial for male faces, which were perceived as less attractive without a mask. However, wearing a mask did not significantly impact already attractive faces. The eye-tracking results revealed that the periorbital region attracted more attention and was fixated on more quickly while wearing a mask, indicating the importance of eyes in social interaction and aesthetic perception.
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Affiliation(s)
- Cosima Prahm
- University of Tuebingen, Faculty of Medicine, Department of Hand, Plastic and Reconstructive Surgery, Tuebingen, Germany; BG Klinik Tuebingen, Clinic for Hand, Plastic, Reconstructive and Burn Surgery, Schnarrenbergstr. 95, Tuebingen, Germany.
| | - Julia Konieczny
- University of Tuebingen, Faculty of Medicine, Department of Hand, Plastic and Reconstructive Surgery, Tuebingen, Germany
| | - Michael Bressler
- BG Klinik Tuebingen, Clinic for Hand, Plastic, Reconstructive and Burn Surgery, Schnarrenbergstr. 95, Tuebingen, Germany
| | - Johannes Heinzel
- University of Tuebingen, Faculty of Medicine, Department of Hand, Plastic and Reconstructive Surgery, Tuebingen, Germany; BG Klinik Tuebingen, Clinic for Hand, Plastic, Reconstructive and Burn Surgery, Schnarrenbergstr. 95, Tuebingen, Germany
| | - Adrien Daigeler
- University of Tuebingen, Faculty of Medicine, Department of Hand, Plastic and Reconstructive Surgery, Tuebingen, Germany; BG Klinik Tuebingen, Clinic for Hand, Plastic, Reconstructive and Burn Surgery, Schnarrenbergstr. 95, Tuebingen, Germany
| | - Jonas Kolbenschlag
- BG Klinik Tuebingen, Clinic for Hand, Plastic, Reconstructive and Burn Surgery, Schnarrenbergstr. 95, Tuebingen, Germany
| | - Henrik Lauer
- BG Klinik Tuebingen, Clinic for Hand, Plastic, Reconstructive and Burn Surgery, Schnarrenbergstr. 95, Tuebingen, Germany
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Use of Micro Botulinum Toxin for a Face-lifting Effect: A Systematic Review. Dermatol Surg 2022; 48:849-854. [PMID: 35560135 DOI: 10.1097/dss.0000000000003483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Micro-Botox (Micro-btx) was described in 2000 for the paralysis of superficial muscle fibers to address facial rhytides. Increasingly, there are reports of its off-label use for a face-lifting effect. OBJECTIVE To evaluate the literature for such results. METHODS AND METHODS A systematic review was performed according to PRISMA; only Level ≥ III evidence from 2000 to 2020 were included. Data extracted include patient demographics, type of botulinum toxin, dilution, dosage, injection sites and spacing, needle size and syringe, follow-up, patient and physician assessment, and complications. RESULTS Three hundred seventy-two patients (average 35.2 years) underwent different botulinum toxin injections (average 39 units/hemiface) of varying dilutions with 30- to 32-G needles, typically with 1-mL syringes, by forming 0.2- to 0.5-cm wheals 1 cm apart. Follow-up averaged 10.5 weeks with both subjective and objective assessments. Facial asymmetry and minor bruising were common. Subjective assessment of face-lifting effects between patients and physicians was highly discordant and injection sites reported were highly variable. CONCLUSION Much heterogeneity in dosage, injection sites, definition of "face-lifting," and assessment methods remain, all of which preclude accurate and objective evaluation of the current evidence for micro-btx. Future studies should address these variables, given the growing interest in such nonsurgical options for a face-lifting effect.
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Impact of Surgical Rejuvenation on Visual Processing and Character Attribution of Periorbital Aging. Plast Reconstr Surg 2022; 150:539-548. [PMID: 35749255 DOI: 10.1097/prs.0000000000009458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Effect of Surgical versus Nonsurgical Rhinoplasty on Perception of the Patient. Facial Plast Surg Clin North Am 2022; 30:175-181. [DOI: 10.1016/j.fsc.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Frautschi RS, Zins JE. Commentary on: How Does Wearing a Facecover Influence the Eye Movement Pattern in Times of COVID-19? Aesthet Surg J 2021; 41:NP1125-NP1126. [PMID: 33942059 PMCID: PMC8135967 DOI: 10.1093/asj/sjab213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Russell S Frautschi
- Department of Plastic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
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