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Jankowski M, Goroncy A. Anatomical variants of acne differ in their impact on social perception. J Eur Acad Dermatol Venereol 2024; 38:1628-1636. [PMID: 38379351 DOI: 10.1111/jdv.19798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 12/11/2023] [Indexed: 02/22/2024]
Abstract
BACKGROUND Acne negatively affects quality of life, however quality-of-life scores poorly correlate with disease severity scores. Previous research demonstrated existence of facial areas in which skin lesions have greater impact on gaze patterns. Therefore, we hypothesized that anatomical variants of acne may be perceived differently. OBJECTIVES The aim was to investigate effect of anatomical variants of acne on natural gaze patterns and resulting impact on social perception of acne patients. METHODS We tracked eye movements of participants viewing neutral and emotional faces with acne. Images were rated for acne-related visual disturbance, and emotional faces were rated for valence intensity. Respondents of an online survey were asked to rate their perception of pictured individuals' personality traits. RESULTS All faces with acne were perceived as less attractive and received poorer personality judgements with mid-facial acne presenting smallest deviation from healthy faces. T-zone and mixed acne exhibited the least significant difference in respondents gaze behaviour pattern from each other. In addition, there was no significant difference in respondents' grading of acne visual disturbance or ratings for attractiveness, success and trustworthiness. U-zone adult female acne was rated as the most visually disturbing and received the lowest scores for attractiveness. Happy faces with adult female acne were rated as less happy compared to other acne variants and clear-skin faces. CONCLUSIONS Anatomic variants of acne have a distinct impact on gaze patterns and social perception. Adult female acne has the strongest negative effect on recognition of positive emotions in affected individuals, attractiveness ratings and forming social impressions. If perioral acne lesions are absent, frontal lesions determine impact of acne on social perception irrespective of the presence of mid-facial lesions. This perceptive hierarchy should be taken into consideration while deciding treatment goals in acne patients, prioritizing achieving remission in perioral and frontal area.
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Affiliation(s)
- Marek Jankowski
- Department of Dermatology and Venereology, Faculty of Medicine in Bydgoszcz, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Agnieszka Goroncy
- Department of Mathematical Statistics and Data Mining, Faculty of Mathematics and Computer Science, Nicolaus Copernicus University in Torun, Torun, Poland
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Kamal M, Möbius M, Bartella AK, Lethaus B. Perception of aesthetic features after surgical treatment of craniofacial malformations by observers of the same age: An eye-tracking study. J Craniomaxillofac Surg 2023; 51:708-715. [PMID: 37813772 DOI: 10.1016/j.jcms.2023.09.009] [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: 12/29/2022] [Revised: 02/11/2023] [Accepted: 09/30/2023] [Indexed: 10/11/2023] Open
Abstract
The aim of this study is to evaluate where exactly children and adolescents of the same group look when they interact with each other, and attempt to record and analyse the data recorded by eye-tracking technology. MATERIALS AND METHODS 60 subjects participated in the study, evenly divided into three age categories of 20 each in pre-school/primary school age (5-9 years), early adolescence (10-14 years) and late adolescence/transition to adulthood (15-19 years). Age groups were matched and categorized to be used both for creating the picture series and testing. Photographs of patients with both unilateral and bilateral cleft lip and palate were used to create the series of images which consisted of a total of 15 photos, 5 of which were photos of patients with surgically treated cleft deformity and 10 control photos with healthy faces, that were presented in random order. Using the eye-tracking module, the data on "area of first view" (area of initial attention), "area with longest view" (area of sustained attention), "time until view in this area" (time of initial attention) and "frequency of view in each area" (time of sustained attention) were calculated. RESULTS Across all groups, there was no significant difference for the individual regions for the parameters of initial attention (area of first view), while the time until first fixation of one of the AOIs (time until view in this area) was significant for all facial regions. A predictable path of the facial scan is abandoned when secondary facial deformities are present and attention is focused more on the region of an existing deformity, which are the nose and mouth regions. CONCLUSIONS There are significant differences in both male and female participants' viewing of faces with and without secondary cleft deformity. While in the age group of the younger test persons it was still the mouth region that received special attention from the male viewers, this shifted in the male test persons of the middle age group to the nose region, which was fixed significantly more often and faster. In the female participants, the mouth and nose regions were each looked at for twice as long compared to the healthy faces, making both the mouth and the nose region are in the focus of observation.
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Affiliation(s)
- Mohammad Kamal
- Department of Surgical Sciences, College of Dentistry, Health Sciences Center, Kuwait University, Safat, Kuwait.
| | - Marianne Möbius
- Department of Oral and Maxillofacial Surgery, Leipzig University Hospital, Leipzig, Germany.
| | - Alexander K Bartella
- Department of Oral and Maxillofacial Surgery, Leipzig University Hospital, Leipzig, Germany.
| | - Bernd Lethaus
- Department of Oral and Maxillofacial Surgery, Leipzig University Hospital, Leipzig, Germany.
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Bhadila GY, Alyafi DA. The Use of Eye-Tracking Technology in Pediatric Orofacial Clefts: A Systematic Review and Meta-Analysis. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1425. [PMID: 37628424 PMCID: PMC10453381 DOI: 10.3390/children10081425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/14/2023] [Accepted: 08/18/2023] [Indexed: 08/27/2023]
Abstract
This systematic review and meta-analysis assessed the quality of the peer-reviewed literature and evaluated the usefulness of eye-tracking technology in evaluating observers' perceptions of pediatric patients with orofacial clefts. PubMed, Science Direct, Wiley, and Web of Science were searched. Articles were screened in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis guidelines, and their methodological quality was assessed. Of the 10,254 identified studies, 12 were included. Eleven studies were cross-sectional, and one was a prospective cohort study. The main areas of interest analyzed were the eyes, nose, and mouth. Nine studies used assessment scales to analyze the link between perceived attractiveness and visualization patterns and measures. For the fixation duration outcome, six studies were eligible for inclusion in the meta-analysis. All studies reported on fixation duration in milliseconds and reported on a standard deviation. The meta-analysis demonstrated a significant difference in the measurements between the control groups and the patients with orofacial clefts. This might indicate the usefulness of eye-tracking technology as a metric for assessing the success of cleft repairs based on the perceptions of different populations. Future studies should be comprehensively reported on for comparability and reproducibility purposes.
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Affiliation(s)
- Ghalia Y. Bhadila
- Department of Pediatric Dentistry, Faculty of Dentistry, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Dana A. Alyafi
- Department of Orthodontics, Faculty of Dentistry, King Abdulaziz University, Jeddah 21589, Saudi Arabia;
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Plonkowski AT, Breakey RWF, Read JCA, Sainsbury DCG. The Use of Eye-tracking Technology in Cleft Lip: A Literature Review. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e4980. [PMID: 37360237 PMCID: PMC10287128 DOI: 10.1097/gox.0000000000004980] [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: 12/12/2022] [Accepted: 03/17/2023] [Indexed: 06/28/2023]
Abstract
Eye-tracking has become an increasingly popular research tool within the field of cleft lip and/or palate (CL+/-P). Despite this, there are no standardized protocols for conducting research. Our objective was to conduct a literature review of the methodology and outcomes of previous publications using eye-tracking in CL+/-P. Methods The PubMed, Google Scholar, and Cochrane databases were searched to identify all articles published up to August 2022. All articles were screened by two independent reviewers. Inclusion criteria included using eye-tracking, image stimuli of CL+/-P, and outcome reporting using areas of interest (AOIs). Exclusion criteria included non-English studies, conference articles, and image stimuli of conditions other than CL+/-P. Results Forty articles were identified, and 16 met the inclusion/exclusion criteria. Thirteen studies only displayed images of individuals following cleft lip surgery with three only displaying unrepaired cleft lips. Significant variation was found in study design, particularly in the AOIs used to report gaze outcomes. Ten studies asked participants to provide an outcome score alongside eye-tracking; however, only four compared outcome data to eye-tracking data. This review is primarily limited by the minimal number of publications in this area. Conclusions Eye-tracking can be a powerful tool in evaluating appearance outcomes following CL+/-P surgery. It is currently limited by the lack of standardized research methodology and varied study design. Before future work, a replicable protocol should be developed to maximize the potential of this technology.
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Affiliation(s)
- Alexander T. Plonkowski
- From the School of Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
- Cleft Lip and Palate Service, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - R. William F. Breakey
- Cleft Lip and Palate Service, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Jenny C. A. Read
- Department of Vision Science, Biosciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - David C. G. Sainsbury
- Cleft Lip and Palate Service, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
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Parents of Children with Cleft Lip Exhibit Heightened Visual Attention to the Perioral Area. Plast Reconstr Surg Glob Open 2023; 11:e4790. [PMID: 36798720 PMCID: PMC9925101 DOI: 10.1097/gox.0000000000004790] [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: 10/15/2022] [Accepted: 11/28/2022] [Indexed: 02/16/2023]
Abstract
Following high-quality surgical repair, children born with a cleft lip anomaly may still display lasting visual differences. We exposed control adults and parents of affected children to images of children with cleft deformity and compared their visual tracking patterns. The protocol investigated whether parental exposure to secondary cleft deformity heightens or diminishes visual attraction to this type of structural facial variation. Method Twenty participants (10 control adults, 10 parents of affected children) assessed 40 colored images of children's faces while their eye movements were tracked. Twenty-four control images and 16 repaired cleft lip images were displayed to observers. Nine bilateral facial aesthetic zones were considered as regions of interest. Percentage of time visually fixating within each region, and statistical differences in fixation duration percentage between the two participant groups and across the bilateral regions of interest were analyzed. Results While both groups of observers directed more visual attention to the nasal and oral regions of the cleft images than control images, parents of children with cleft lip spent significantly more time fixating on these areas (25% and 24% of the time, respectively) than did unaffected adults (14.6% and 19.3%; P < 0.001). Conclusions These results demonstrate that parents of cleft lip children exhibit heightened attention to this type of facial difference relative to the naive observer. These findings highlight that observer profile can meaningfully influence the perception of a facial deformity. Awareness of this information may enhance communication between surgeon and parents of an affected child by providing added insight into parental perspective.
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Frank K, Ehrl D, Bernardini F, Walbrun A, Moellhoff N, Alfertshofer M, Davidovic K, Mardini S, Gotkin RH, Cotofana S. How We Look At Mature Faces-An Eye-Tracking Investigation Into the Perception of Age. Aesthet Surg J 2023; 43:115-122. [PMID: 36099471 DOI: 10.1093/asj/sjac251] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/06/2022] [Accepted: 09/06/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND It is still unclear which facial region contributes most to the perception of an aged face when evaluated by eye-tracking analyses. OBJECTIVES The authors sought to apply eye-tracking technology to identify whether mature faces require longer fixation durations than young faces and which facial region contributes most to the perception of a mature face. METHODS Eye-tracking analyses were conducted in 74 volunteers (37 males, 37 females; 43 ≤ 40 years, 31 > 40 years) evaluating their gaze pattern and the fixation durations for the entire face and 9 facial subregions. Frontal facial images of 16 younger (<40 years) and older (>40 years) gender-matched individuals were presented in a standardized setting. RESULTS Independent of age or gender of the observer, a younger stimulus image was viewed shorter than an older stimulus image with 0.82 (0.63) seconds vs 1.06 (0.73) seconds with P < 0.001. There was no statistically significant difference in their duration of a stable eye fixation when observers inspected a male vs a female stimulus image [0.94 (0.70) seconds vs 0.94 (0.68) seconds; P = 0.657] independent of the observer's age or gender. The facial image that captured the most attention of the observer (rank 9) was the perioral region with 1.61 (0.73) seconds for younger observers and 1.57 (0.73) seconds for older observers. CONCLUSIONS It was revealed that the perioral region attracts the most attention of observers and contributes most to an aged facial appearance. Practitioners should be mindful of the importance of the perioral region when designing an aesthetic treatment plan.
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Affiliation(s)
- Konstantin Frank
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Denis Ehrl
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | | | - Alina Walbrun
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Nicholas Moellhoff
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Michael Alfertshofer
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Kristina Davidovic
- Department of Radiology and Medical School, University of Belgrade, Belgrade, Serbia
| | - Samir Mardini
- Department of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Sebastian Cotofana
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
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Hartmann GC, Guimarães LK, Maggioni CG, Gasparello GG, Júnior SLM, Pithon MM, Tanaka OM. Social attractiveness perception of a cleft lip repair in an adolescent via eye-tracking. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:e526-e532. [PMID: 35074565 DOI: 10.1016/j.jormas.2022.01.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/13/2022] [Accepted: 01/15/2022] [Indexed: 06/14/2023]
Abstract
PURPOSE The present study was designed to investigate the perception of unilateral cleft lip (UCL) repair scar using an image of an adolescent and eye-tracking technology. MATERIAL AND METHODS Frontal and oblique views of an image of an adolescent with a unilateral upper lip scar result of a corrective surgery. Eighty-five laypeople respondents were divided into three groups: Group A (15-44 years of age); Group B (45-59 years of age); and Group C (≥ 60 years of age). Gaze tracking was carried out to assess the location on the image of greatest fixation, to create dot maps and to follow the trajectory of the gaze. Respondents also assessed six attention questionnaires. The answers and assessment of the VAS were compared. P-values <0.05 were considered significant in the analyses. RESULTS The central focus of the visualization was concentrated on the upper lip and the region of the nostril, followed by the eyes. Time until 1st fixation upon right lip and mouth showed differences with regard to different images. Images of the model shown in various guises including smiling or not, in a frontal or oblique views showed significant differences in VAS scoring (p<0.001). CONCLUSION The presence of a scar from the UCL repair in an adolescent was noted in the foreground by laypeople. The scar was associated with a lower degree of attractiveness, happiness, and intelligence, as well as with shyness and sympathy, although a visible scar did not influence the perception of "good hygiene habits".
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Affiliation(s)
- Giovani Ceron Hartmann
- Pontifícia Universidade Católica do Paraná, Curitiba, Brazil; School of Life Sciences, Brazil
| | - Lara Karolina Guimarães
- Pontifícia Universidade Católica do Paraná, Curitiba, Brazil; School of Life Sciences, Brazil
| | | | | | - Sergio Luiz Mota Júnior
- Visiting Professor of Orthodontics in Juiz de Fora Federal University, Juiz de Fora, Minas Gerais, Brazil, Private Practice
| | - Matheus Melo Pithon
- Southwest Bahia State University - UESB. Jequié, Bahia, Brazil; Diplomate of the Brazilian Board of Orthodontics - BBO, Brazil
| | - Orlando Motohiro Tanaka
- Pontifícia Universidade Católica do Paraná, Curitiba, Brazil; School of Life Sciences, Brazil; Diplomate of Brazilian Board of Orthodontics and Dentofacial Orthopedics, Postdoctoral Fellow at The Center for Advanced Dental Education at Saint Louis University, Brazil; Pontifícia Universidade Católica do Paraná - PUCPR, School of Life Sciences, R. Imaculada Conceição, 1155, CEP: 80215-901 - CURITIBA, Paraná, BRAZIL.
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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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9
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Nunes D, Bran G. The Impact of the Philtrum on Facial Attractiveness, Perioral Proportions, and Perceptions of Facial Aging. Aesthet Surg J 2021; 41:816-825. [PMID: 32582914 DOI: 10.1093/asj/sjaa174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Lip enhancement continues to be one of the most popular facial procedures. State-of-the-art lip enhancement involves sculpting of perilabial soft tissue, in particular, the philtrum, but it is unclear how patients perceive their philtral contours. OBJECTIVES The aim of this study was to test the impact of the philtrum on attractiveness, and on the perception of facial proportions and age. METHODS Respondents (1100, including 50 aesthetic specialists) were presented with 2 sets of identical portraits, 1 set of a young Caucasian female and 1 set of an aged Caucasian female, with 1 portrait in each set having an upper lip lacking any philtral contours. The respondents were asked to choose which upper lip was more attractive, appeared longer, and looked older. Rankings were analyzed according to population demographics. RESULTS Overall, most respondents considered the young face (84%) and the aged face (68%) with philtral contours to be more attractive. Moreover, the majority of respondents (81%) considered the upper lip of the young face without a philtrum to appear longer in a craniocaudal orientation (67% for the aged image), and 67% of respondents described the image of the young woman with no philtral definition as appearing older (55% for the aged face with no philtrum). CONCLUSIONS This study confirms the authors' hypothesis that the existence of philtral contours exerts a significant impact on perioral attractiveness, and that its absence can be related to a longer appearance of the upper lip as well as an older facial appearance.
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Affiliation(s)
- Diogo Nunes
- Department of Otolaryngology, Head and Neck Surgery, Klinikum Bremen-Mitte, Bremen, Germany
| | - Gregor Bran
- Department of Otolaryngology, Head and Neck Surgery, University Hospital Mannheim, Mannheim, Germany
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Bous RM, Lyamichev A, Kmentt A, Valiathan M. Bias in a blink: Shedding light on implicit attitudes toward patients with a cleft lip. Am J Orthod Dentofacial Orthop 2021; 160:200-208. [PMID: 33958261 DOI: 10.1016/j.ajodo.2020.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 03/01/2020] [Accepted: 04/01/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Previous studies have shown that patients with cleft lip and/or palate may be stigmatized in society. The objective of this study was to use an implicit association test to evaluate the subconscious biases of non-health care providers and orthodontists against patients with a repaired cleft lip (CL). METHODS Respondents participated in an implicit association test. Pictures of patients with CL and controls were shown to participants, along with terms representing positive and negative attributes. Participants were prompted to match pictures to the attributes. The software algorithm detected whether the participants were more likely to associate CL with positive or negative terms than controls. Demographic information was collected to measure the association between some sociodemographic factors and implicit biases. RESULTS Of 130 valid participants, 52 were orthodontists and 78 were non-health care providers. The entire sample displayed a significant implicit bias against CL (P <0.001). Overall, orthodontists tended to exhibit slightly higher levels of implicit biases against CL than non-health care providers, but the difference was not significant when controlling for sociodemographic factors (P = 0.34). Females showed significantly lower implicit biases against CL than males (P = 0.046). Spearman correlations showed that older people and those who reported a more conservative political affiliation tended to show slightly higher levels of implicit biases against CL (P <0.007). CONCLUSIONS Orthodontists and non-health care providers showed moderate but significant levels of implicit biases against patients with clefts. Males, older age groups, and patients with a more conservative political affiliation tended to exhibit slightly higher levels of biases than females, younger people, and those with a more liberal political affiliation.
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Affiliation(s)
- Rany M Bous
- Craniofacial and Special Care Orthodontics, Department of Orthodontics, School of Dental Medicine, Case Western Reserve University, Cleveland, Ohio.
| | - Anthony Lyamichev
- School of Dental Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Ashleigh Kmentt
- School of Dental Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Manish Valiathan
- Mt Sinai-Dr Edward Reiter Fellowship Program, Department of Orthodontics, School of Dental Medicine, Case Western Reserve University, Cleveland, Ohio
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11
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Assessing abdominoplasty aesthetics in women with eye-tracking technology—do patients see things differently? EUROPEAN JOURNAL OF PLASTIC SURGERY 2021. [DOI: 10.1007/s00238-020-01771-4] [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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Asaad M, Dey JK, Al-Mouakeh A, Manjouna MB, Nashed MA, Rajesh A, Boonipat T, Bite U. Eye-Tracking Technology in Plastic and Reconstructive Surgery: A Systematic Review. Aesthet Surg J 2020; 40:1022-1034. [PMID: 32010929 DOI: 10.1093/asj/sjz328] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The use of eye-tracking technology in plastic surgery has gained popularity over the past decade due to its ability to assess observers' visual preferences in an objective manner. OBJECTIVES The goal of this study was to provide a comprehensive review of eye-tracking studies in plastic and reconstructive surgery, which can aid in the design and conduct of high-quality eye-tracking studies. METHODS Through application of Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) guidelines, a comprehensive search of articles published on eye-tracking across several databases was conducted from January 1946 to January 2019. Inclusion criteria included studies evaluating the use of eye-tracking technology in the field of plastic and reconstructive surgery. The resulting publications were screened by 2 independent reviewers. RESULTS A total of 595 articles were identified, 23 of which met our inclusion criteria. The most common application of eye-tracking was to assess individuals with cleft lip/palate (9 studies). All 19 studies that evaluated fixation patterns among conditions vs controls reported significant differences between the 2 groups. Five out of 7 studies assessing visual data between preoperative and postoperative patients identified significant differences between the preoperative and postoperative groups, whereas 2 studies did not. Nine studies examined the relation between severity indices, attractiveness scores, or personality ratings and gaze patterns. Correlation was found in 7 out of the 9 studies. CONCLUSIONS This systematic review demonstrates the utility of eye-tracking technology as a quantifiable objective assessment and emerging research tool for evaluating outcomes in several domains of plastic and reconstructive surgery.
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Affiliation(s)
- Malke Asaad
- Division of Plastic Surgery, Mayo Clinic, Rochester, MN
| | - Jacob K Dey
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN
| | | | | | | | | | | | - Uldis Bite
- Division of Plastic Surgery, Mayo Clinic, Rochester, MN
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13
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Anderies BJ, Dey JK, Gruszczynski NR, Price DL, Moore EJ, Janus JR. Dermal Fat Grafting to Reconstruct the Parotidectomy Defect Normalizes Facial Attention. Laryngoscope 2020; 131:E124-E131. [PMID: 32658339 DOI: 10.1002/lary.28890] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 05/18/2020] [Accepted: 06/03/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS Use validated eye-tracking technology to objectively measure 1) the attentional distraction of facial contour defects after superficial and total parotidectomy and 2) changes in attentional distraction with abdominal dermal fat graft reconstruction. METHODS Standardized frontal and oblique facial images of 16 patients who had undergone superficial or total parotidectomy with or without fat graft reconstruction; four normal controls were obtained. One hundred casual observers were recruited to view these images, and gaze data were collected using a Tobii Pro eye-tracking system. Gaze durations for predefined facial areas of interest were analyzed using mixed-effects linear regression to test study hypotheses. RESULTS For frontal images, total parotidectomy increased gaze to the operated parotid area compared to the contralateral nonoperated parotid area (92 milliseconds, 95% confidence interval [CI]: 48-138 milliseconds, P < .001). Fat grafting normalized the attentional distraction, with no difference in gaze time on the operated parotid region compared to normal control faces (P = .414). For oblique images, total parotidectomy increased gaze to the operated parotid area compared to the contralateral nonoperated parotid area (658 milliseconds, 95% CI: 463-854 milliseconds, P < .001). Fat grafting normalized this attentional distraction, with no difference in gaze time on the operated parotid region compared to normal control faces (P = .504). In both views, superficial parotidectomy demonstrated no significant attentional distractions, with or without fat grafting. CONCLUSIONS This eye-tracking study objectively demonstrates that total parotidectomy results in a facial contour deformity that is distracting to observers, whereas superficial parotidectomy does not. For total parotidectomy, this attentional distraction can be normalized with dermal fat graft reconstruction. LEVEL OF EVIDENCE 3b Laryngoscope, 131:E124-E131, 2021.
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Affiliation(s)
- Barrett J Anderies
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jacob K Dey
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Nelson R Gruszczynski
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel L Price
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Eric J Moore
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jeffrey R Janus
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Jacksonville, Florida, USA
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14
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Pressler MP, Geisler EL, Hallac RR, Seaward JR, Kane AA. The Use of Eye Tracking to Discern the Threshold at Which Metopic Orbitofrontal Deformity Attracts Attention. Cleft Palate Craniofac J 2020; 57:1392-1401. [PMID: 32489115 DOI: 10.1177/1055665620926014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES Surgical treatment for trigonocephaly aims to eliminate a stigmatizing deformity, yet the severity that captures unwanted attention is unknown. Surgeons intervene at different points of severity, eliciting controversy. This study used eye tracking to investigate when deformity is perceived. MATERIAL AND METHODS Three-dimensional photogrammetric images of a normal child and a child with trigonocephaly were mathematically deformed, in 10% increments, to create a spectrum of 11 images. These images were shown to participants using an eye tracker. Participants' gaze patterns were analyzed, and participants were asked if each image looked "normal" or "abnormal." RESULTS Sixty-six graduate students were recruited. Average dwell time toward pathologic areas of interest (AOIs) increased proportionally, from 0.77 ± 0.33 seconds at 0% deformity to 1.08 ± 0.75 seconds at 100% deformity (P < .0001). A majority of participants did not agree an image looked "abnormal" until 90% deformity from any angle. CONCLUSION Eye tracking can be used as a proxy for attention threshold toward orbitofrontal deformity. The amount of attention toward orbitofrontal AOIs increased proportionally with severity. Participants did not generally agree there was "abnormality" until deformity was severe. This study supports the assertion that surgical intervention may be best reserved for more severe deformity.
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Affiliation(s)
- Mark P Pressler
- Department of Plastic Surgery, 12334UT Southwestern, Dallas, TX, USA.,Analytical Imaging and Modeling Center, Children's Medical Center, Dallas, TX, USA
| | - Emily L Geisler
- Department of Plastic Surgery, 12334UT Southwestern, Dallas, TX, USA.,Analytical Imaging and Modeling Center, Children's Medical Center, Dallas, TX, USA
| | - Rami R Hallac
- Department of Plastic Surgery, 12334UT Southwestern, Dallas, TX, USA.,Analytical Imaging and Modeling Center, Children's Medical Center, Dallas, TX, USA
| | - James R Seaward
- Department of Plastic Surgery, 12334UT Southwestern, Dallas, TX, USA.,Analytical Imaging and Modeling Center, Children's Medical Center, Dallas, TX, USA
| | - Alex A Kane
- Department of Plastic Surgery, 12334UT Southwestern, Dallas, TX, USA.,Analytical Imaging and Modeling Center, Children's Medical Center, Dallas, TX, USA
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15
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Unilateral Cleft Lip Nasal Deformity: Three-Dimensional Analysis of the Primary Deformity and Longitudinal Changes following Primary Correction of the Nasal Foundation. Plast Reconstr Surg 2020; 145:185-199. [PMID: 31592947 DOI: 10.1097/prs.0000000000006389] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Objective assessment of the unilateral cleft lip nasal deformity and the longitudinal changes with treatment is critical for optimizing cleft care. METHODS Consecutive patients undergoing cleft lip repair and foundation-based rhinoplasty were included (n = 102). Three-dimensional images preoperatively, postoperatively, and at 5 years of age were assessed and compared to age-matched controls. Images were normalized to standard horizontal, craniocaudal, and anteroposterior axes. RESULTS Cleft subalare was similar in position relative to controls but was 1.6 mm retrodisplaced. Subnasale was deviated 4.6 mm lateral to midline and had the greatest displacement of any landmark. Noncleft subalare was displaced 2.3 mm laterally. Regression analysis with deviation of subnasale from the midline as a dependent variable revealed progressive lateral displacement of noncleft subalare, narrowing of noncleft nostril, and intercanthal widening. Surgery corrected nasal base displacements along all axes, resulting in landmark positions similar to controls. Symmetry of nasal base correction persisted at 5-year follow-up, with no recurrent cleft alar base retrusion, regardless of initial cleft type. CONCLUSIONS Unilateral cleft lip nasal deformity may be "driven" by displacement of the anterior nasal spine and caudal septum. The cleft alar base is normal in position but retruded, whereas the noncleft alar base is displaced laterally. Changes with surgery involve anterior movement of the cleft alar base but also include medial movement of the noncleft alar base and columella. Symmetry of correction, including alar base retrusion, was stable over time and did not rely on alveolar bone grafting.
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16
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Dey JK, Ishii LE, Boahene KDO, Byrne PJ, Ishii M. Measuring Outcomes of Mohs Defect Reconstruction Using Eye-Tracking Technology. JAMA FACIAL PLAST SU 2020; 21:518-525. [PMID: 31670742 DOI: 10.1001/jamafacial.2019.1072] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Objectively measuring how Mohs defect reconstruction changes casual observer attention has important implications for patients and facial plastic surgeons. Objective To use eye-tracking technology to objectively measure the ability of Mohs facial defect reconstruction to normalize facial attention. Design, Setting, and Participants This observational outcomes study was conducted at an academic tertiary referral center from January to June 2016. An eye-tracking system was used to record how 82 casual observers directed attention to photographs of 32 patients with Mohs facial defects of varying sizes and locations before and after reconstruction as well as 16 control faces with no facial defects. Statistical analysis was performed from November 2018 to January 2019. Main Outcomes and Measures First, the attentional distraction caused by facial defects was quantified in milliseconds of gaze time using eye tracking. Second, the eye-tracking data were analyzed using mixed-effects linear regression to assess the association of facial defect reconstruction with normalized facial attention. Results The 82 casual observers (63 women and 19 men; mean [SD] age, 34 [12] years) viewed control faces in a similar and consistent fashion, with most attention (65%; 95% CI, 62%-69%) directed at the central triangle, which includes the eyes, nose, and mouth. The eyes were the most visually important feature, capturing a mean of 60% (95% CI, 57%-64%) of fixation time within the central triangle and 39% (95% CI, 36%-43%) of total observer attention. The presence of Mohs defects was associated with statistically significant alterations in this pattern of normal facial attention. The larger the defect and the more centrally a defect was located, the more attentional distraction was observed, as measured by increased attention on the defect and decreased attention on the eyes, ranging from 729 (95% CI, 526-931) milliseconds for small peripheral defects to 3693 (95% CI, 3490-3896) milliseconds for large central defects. Reconstructive surgery was associated with improved gaze deviations for all faces and with normalized attention directed to the eyes for all faces except for those with large central defects. Conclusions and Relevance Mohs defects are associated with altered facial perception, diverting attention from valuable features such as the eyes. Reconstructive surgery was associated with normalized attentional distraction for many patients with cutaneous Mohs defects. These data are important to patients who want to know how reconstructive surgery could change the way people look at their face. The data also point to the possibility of outcomes prediction based on facial defect size and location before reconstruction. Eye tracking is a valuable research tool for outcomes assessment that lays the foundation for understanding how reconstructive surgery may change perception and normalize facial deformity.
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Affiliation(s)
- Jacob K Dey
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Lisa E Ishii
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Kofi D O Boahene
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Patrick J Byrne
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Masaru Ishii
- Division of Rhinology, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
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17
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Karp E, Scott A, Martin K, Zavala H, Chinnadurai S, Roby B. Developing an Eye-Tracking Protocol to Determine Children’s Visual Perception of Secondary Cleft Lip Deformity. Cleft Palate Craniofac J 2019; 57:321-326. [DOI: 10.1177/1055665619868332] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: To develop a protocol that will be used to measure children’s perception of secondary cleft lip deformity (SCLD) using objective eye-tracking technology. Design: Cross-sectional study. Data collection May and June of 2018. Setting: Single tertiary care pediatric hospital with a well-established cleft team. Participants: Participants were recruited from a general pediatric otolaryngology clinic. Sixty participants from 4 age groups (5-6, 10, 13, and 16 years) were enrolled on a voluntary basis. Intervention: Pediatric participants viewed images of children’s faces while wearing eye-tracking glasses. Ten images with unilateral SCLD and 2 control images with no facial scarring were viewed as gaze was assessed. Main Outcome and Measure: Successful gaze fixation was recorded across all age groups. Results: This article illustrates the types of data generated from glasses-based eye tracking in children. All children, regardless of age, spent more time with their gaze on a SCLD images (mean = 4.23 seconds; standard deviation [SD] = 1.41 seconds) compared to control images (mean = 3.97 seconds; SD = 1.42). Younger age groups spent less time looking at specific areas of interest in SCLD images. Conclusion: In this pilot study, we were able to successfully use eye-tracking technology in children to demonstrate gaze preference and a trend toward visual perception of SCLD changing with age. This protocol will allow for a future study, with larger and more diverse populations. Better understanding of how SCLD is perceived among children and adolescents has the potential to guide future interventions for SCLD and other facial deformities in pediatric patients.
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Affiliation(s)
- Emily Karp
- Department of Otolaryngology—Head and Neck Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Andrew Scott
- Department of Pediatric Otolaryngology, Tufts University, Boston, MA, USA
| | | | - Hanan Zavala
- Department of Pediatric ENT and Facial Plastic Surgery, Children’s of Minnesota, Saint Paul, MN, USA
| | - Siva Chinnadurai
- Department of Otolaryngology—Head and Neck Surgery, University of Minnesota, Minneapolis, MN, USA
- Department of Pediatric ENT and Facial Plastic Surgery, Children’s of Minnesota, Saint Paul, MN, USA
| | - Brianne Roby
- Department of Otolaryngology—Head and Neck Surgery, University of Minnesota, Minneapolis, MN, USA
- Department of Pediatric ENT and Facial Plastic Surgery, Children’s of Minnesota, Saint Paul, MN, USA
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