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Yang X, Li R, Yang X, Zhou Y, Liu Y, Han JDJ. Coordinate-wise monotonic transformations enable privacy-preserving age estimation with 3D face point cloud. SCIENCE CHINA. LIFE SCIENCES 2024; 67:1489-1501. [PMID: 38573362 DOI: 10.1007/s11427-023-2518-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 12/25/2023] [Indexed: 04/05/2024]
Abstract
The human face is a valuable biomarker of aging, but the collection and use of its image raise significant privacy concerns. Here we present an approach for facial data masking that preserves age-related features using coordinate-wise monotonic transformations. We first develop a deep learning model that estimates age directly from non-registered face point clouds with high accuracy and generalizability. We show that the model learns a highly indistinguishable mapping using faces treated with coordinate-wise monotonic transformations, indicating that the relative positioning of facial information is a low-level biomarker of facial aging. Through visual perception tests and computational 3D face verification experiments, we demonstrate that transformed faces are significantly more difficult to perceive for human but not for machines, except when only the face shape information is accessible. Our study leads to a facial data protection guideline that has the potential to broaden public access to face datasets with minimized privacy risks.
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Affiliation(s)
- Xinyu Yang
- School of Life Sciences, Peking University, Beijing, 100871, China
- Peking-Tsinghua Center for Life Sciences, Academy for Advanced Interdisciplinary Studies, Center for Quantitative Biology (CQB), Peking University, Beijing, 100871, China
| | - Runhan Li
- Peking-Tsinghua Center for Life Sciences, Academy for Advanced Interdisciplinary Studies, Center for Quantitative Biology (CQB), Peking University, Beijing, 100871, China
| | - Xindi Yang
- Beijing Key Lab of Traffic Data Analysis and Mining, School of Computer and Information Technology, Beijing Jiaotong University, Beijing, 100044, China
| | - Yong Zhou
- Clinical Research Institute, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Yi Liu
- Beijing Key Lab of Traffic Data Analysis and Mining, School of Computer and Information Technology, Beijing Jiaotong University, Beijing, 100044, China
| | - Jing-Dong J Han
- Peking-Tsinghua Center for Life Sciences, Academy for Advanced Interdisciplinary Studies, Center for Quantitative Biology (CQB), Peking University, Beijing, 100871, China.
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Dundar Yolsal O, Esme P, Karahan S, Tasci I, Caliskan E. Clues for Facial Perceived Age: Exercise, Sun Protection, Photoaging, and Anthropometric Properties: An Observational Cross-Sectional Study. Dermatol Surg 2024:00042728-990000000-00854. [PMID: 38900103 DOI: 10.1097/dss.0000000000004276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
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.
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Affiliation(s)
- Ozlem Dundar Yolsal
- Department of Dermatology and Venereology, University of Health Sciences, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Pelin Esme
- Department of Dermatology and Venereology, University of Health Sciences, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Sevilay Karahan
- Department of Biostatistics, University of Hacettepe, Ankara, Turkey
| | - Ilker Tasci
- Department of Internal Medicine, University of Health Sciences, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Ercan Caliskan
- Department of Dermatology and Venereology, University of Health Sciences, Gulhane Training and Research Hospital, Ankara, Turkey
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Wang J, Gao Y, Wang F, Zeng S, Li J, Miao H, Wang T, Zeng J, Baptista-Hon D, Monteiro O, Guan T, Cheng L, Lu Y, Luo Z, Li M, Zhu JK, Nie S, Zhang K, Zhou Y. Accurate estimation of biological age and its application in disease prediction using a multimodal image Transformer system. Proc Natl Acad Sci U S A 2024; 121:e2308812120. [PMID: 38190540 PMCID: PMC10801873 DOI: 10.1073/pnas.2308812120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 10/12/2023] [Indexed: 01/10/2024] Open
Abstract
Aging in an individual refers to the temporal change, mostly decline, in the body's ability to meet physiological demands. Biological age (BA) is a biomarker of chronological aging and can be used to stratify populations to predict certain age-related chronic diseases. BA can be predicted from biomedical features such as brain MRI, retinal, or facial images, but the inherent heterogeneity in the aging process limits the usefulness of BA predicted from individual body systems. In this paper, we developed a multimodal Transformer-based architecture with cross-attention which was able to combine facial, tongue, and retinal images to estimate BA. We trained our model using facial, tongue, and retinal images from 11,223 healthy subjects and demonstrated that using a fusion of the three image modalities achieved the most accurate BA predictions. We validated our approach on a test population of 2,840 individuals with six chronic diseases and obtained significant difference between chronological age and BA (AgeDiff) than that of healthy subjects. We showed that AgeDiff has the potential to be utilized as a standalone biomarker or conjunctively alongside other known factors for risk stratification and progression prediction of chronic diseases. Our results therefore highlight the feasibility of using multimodal images to estimate and interrogate the aging process.
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Affiliation(s)
- Jinzhuo Wang
- Department of Big Data and Biomedical AI, College of Future Technology, Peking University, Beijing100871, China
| | - Yuanxu Gao
- Macau Institute for AI in Medicine and Zhuhai People’s Hospital and the First Affiliated Hospital of Faculty of Medicine, Macau University of Science and Technology, Macau999087, China
| | - Fangfei Wang
- Macau Institute for AI in Medicine and Zhuhai People’s Hospital and the First Affiliated Hospital of Faculty of Medicine, Macau University of Science and Technology, Macau999087, China
- Guangzhou National Laboratory, Guangzhou510005, China
| | - Simiao Zeng
- Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou510623, China
| | - Jiahui Li
- Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou510623, China
| | - Hanpei Miao
- Dongguan People’s Hospital, Southern Medical University, Dongguan523059, China
| | - Taorui Wang
- Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou510623, China
| | - Jin Zeng
- Guangzhou National Laboratory, Guangzhou510005, China
| | - Daniel Baptista-Hon
- Macau Institute for AI in Medicine and Zhuhai People’s Hospital and the First Affiliated Hospital of Faculty of Medicine, Macau University of Science and Technology, Macau999087, China
| | - Olivia Monteiro
- Macau Institute for AI in Medicine and Zhuhai People’s Hospital and the First Affiliated Hospital of Faculty of Medicine, Macau University of Science and Technology, Macau999087, China
| | - Taihua Guan
- Guangzhou National Laboratory, Guangzhou510005, China
| | - Linling Cheng
- Macau Institute for AI in Medicine and Zhuhai People’s Hospital and the First Affiliated Hospital of Faculty of Medicine, Macau University of Science and Technology, Macau999087, China
| | - Yuxing Lu
- Department of Big Data and Biomedical AI, College of Future Technology, Peking University, Beijing100871, China
| | - Zhengchao Luo
- Department of Big Data and Biomedical AI, College of Future Technology, Peking University, Beijing100871, China
| | - Ming Li
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou325027, China
| | - Jian-kang Zhu
- Institute of Advanced Biotechnology and School of Life Sciences, Southern University of Science and Technology, Shenzhen518055, China
| | - Sheng Nie
- National Clinical Research Center for Kidney Diseases, State Key Laboratory for Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou510515, China
| | - Kang Zhang
- Department of Big Data and Biomedical AI, College of Future Technology, Peking University, Beijing100871, China
- Macau Institute for AI in Medicine and Zhuhai People’s Hospital and the First Affiliated Hospital of Faculty of Medicine, Macau University of Science and Technology, Macau999087, China
- Guangzhou National Laboratory, Guangzhou510005, China
- Dongguan People’s Hospital, Southern Medical University, Dongguan523059, China
| | - Yong Zhou
- Clinical Research Institute, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai201620, China
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González-Alvarez J, Sos-Peña R. The role of facial skin tone and texture in the perception of age. Vision Res 2023; 213:108319. [PMID: 37782999 DOI: 10.1016/j.visres.2023.108319] [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: 11/27/2022] [Revised: 08/20/2023] [Accepted: 09/22/2023] [Indexed: 10/04/2023]
Abstract
Age and gender perception from looking at people's faces, without any cultural or conventional cues, is primarily based on two independent components: a) the shape or facial structure, and b) surface reflectance (skin tone and texture, STT). This study examined the relative contribution of facial STT to the perception of age. A total of 204 subjects participated in four experiments presenting artificial 3D realistic faces of different age versions under two key experimental conditions: with and without STT. Two experiments involved a discrimination-age task, and other two involved a direct age-estimation task. The faces for the last experiment were generated from the photographs of real people. The results were quite consistent throughout the experiments. Data suggest that the contribution of the STT information leads to roughly 25-33 % of accuracy in age perception. Interestingly, a differential pattern emerges in relation to facial age: the relative contribution of skin information increases sharply with advancing age, to the point that age judgments of the older faces (60 years old) without STT information fall to the chance level. This pattern suggests that facial skin tone and texture are the main sources of information for estimating the age of people past their maturity as those are the principal visual signs of aging beyond the anatomical changes of facial structure.
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Affiliation(s)
- Julio González-Alvarez
- Department of Basic and Clinical Psychology and Psychobiology, University Jaume I, Castellón, Spain.
| | - Rosa Sos-Peña
- Department of Basic and Clinical Psychology and Psychobiology, University Jaume I, Castellón, Spain
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Rodríguez Martínez EA, Polezhaeva O, Marcellin F, Colin É, Boyaval L, Sarhan FR, Dakpé S. DeepSmile: Anomaly Detection Software for Facial Movement Assessment. Diagnostics (Basel) 2023; 13:diagnostics13020254. [PMID: 36673064 PMCID: PMC9858579 DOI: 10.3390/diagnostics13020254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/03/2023] [Accepted: 01/05/2023] [Indexed: 01/11/2023] Open
Abstract
Facial movements are crucial for human interaction because they provide relevant information on verbal and non-verbal communication and social interactions. From a clinical point of view, the analysis of facial movements is important for diagnosis, follow-up, drug therapy, and surgical treatment. Current methods of assessing facial palsy are either (i) objective but inaccurate, (ii) subjective and, thus, depending on the clinician's level of experience, or (iii) based on static data. To address the aforementioned problems, we implemented a deep learning algorithm to assess facial movements during smiling. Such a model was trained on a dataset that contains healthy smiles only following an anomaly detection strategy. Generally speaking, the degree of anomaly is computed by comparing the model's suggested healthy smile with the person's actual smile. The experimentation showed that the model successfully computed a high degree of anomaly when assessing the patients' smiles. Furthermore, a graphical user interface was developed to test its practical usage in a clinical routine. In conclusion, we present a deep learning model, implemented on open-source software, designed to help clinicians to assess facial movements.
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Affiliation(s)
- Eder A. Rodríguez Martínez
- UR 7516 Laboratory CHIMERE, University of Picardie Jules Verne, 80039 Amiens, France
- Institut Faire Faces, 80000 Amiens, France
- Correspondence: (E.A.R.M.); (S.D.); Tel.: +33-(0)-22-08-90-48 (E.A.R.M.)
| | - Olga Polezhaeva
- UR 7516 Laboratory CHIMERE, University of Picardie Jules Verne, 80039 Amiens, France
- Faculty of Odontology, University of Reims Champagne-Ardenne, 51097 Reims, France
| | - Félix Marcellin
- UR 7516 Laboratory CHIMERE, University of Picardie Jules Verne, 80039 Amiens, France
- Institut Faire Faces, 80000 Amiens, France
| | - Émilien Colin
- UR 7516 Laboratory CHIMERE, University of Picardie Jules Verne, 80039 Amiens, France
- Institut Faire Faces, 80000 Amiens, France
- Maxillofacial Surgery, CHU Amiens-Picardie, 80000 Amiens, France
| | - Lisa Boyaval
- UR 7516 Laboratory CHIMERE, University of Picardie Jules Verne, 80039 Amiens, France
- Faculty of Odontology, University of Reims Champagne-Ardenne, 51097 Reims, France
| | - François-Régis Sarhan
- UR 7516 Laboratory CHIMERE, University of Picardie Jules Verne, 80039 Amiens, France
- Institut Faire Faces, 80000 Amiens, France
- Physiotherapy School, CHU Amiens-Picardie, 80000 Amiens, France
| | - Stéphanie Dakpé
- UR 7516 Laboratory CHIMERE, University of Picardie Jules Verne, 80039 Amiens, France
- Institut Faire Faces, 80000 Amiens, France
- Maxillofacial Surgery, CHU Amiens-Picardie, 80000 Amiens, France
- Correspondence: (E.A.R.M.); (S.D.); Tel.: +33-(0)-22-08-90-48 (E.A.R.M.)
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Tanaka OM, Cavassin LD, Gasparello GG, Meira TM, Miyoshi CS, Hartmann GC. The Esthetics of the Nasolabial Fold and Age in the Elderly Via Eye-Tracking. Contemp Clin Dent 2023; 14:18-24. [PMID: 37249988 PMCID: PMC10209770 DOI: 10.4103/ccd.ccd_539_21] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 11/12/2021] [Accepted: 12/26/2021] [Indexed: 11/09/2022] Open
Abstract
Background Facial aging is associated with the loss of soft tissue fullness. Perioral signs of facial aging can add years to individuals' appearances and even affect their facial expressions in smiling and nonsmiling images. Aims To evaluate the influence of the nasolabial fold on the visual perception of esthetics and age in the elderly, eye-tracking and a visual analog scale were used. Material and Methods This study applied a cross-sectional study using 40 laypeople. Facial images of an elderly woman were modified to include facial expression lines such as nasolabial folds and marionette lines with no folds, intermediate, and accentuated depths folds. Eye tracking was implemented to measure the average number of fixations. Heat maps and dot maps were generated using eye-tracking software. A visual analog scale of attractiveness and age perception questionnaire were also incorporated into the study. Statistical analysis was performed using a significance of (P<0.05). Results The majority of visual attention was paid to the eye and mouth areas. In the images with no folds, the right eye attracted a greater degree of fixation. In the images in which nasolabial folds were accentuated, the mouth area served as an area of high fixation. No statistical difference was observed between the groups in which smiling images were viewed. Nonsmiling images demonstrated significant differences between groups for variables including time until first fixation, complete fixation time, and number of fixations on the eyes and hemifaces. Old age and diminished attractiveness were associated with attenuated nasolabial folds, especially in nonsmiling images. Conclusion The facial lines and expressions of elderly female individuals were assessed by laypeople using eye-tracking, showing that the deeper one's nasolabial folds, the more aged and less attractive one appears, especially in nonsmiling images. Smiling pictures were perceived to be more attractive and youthful; these perceptions should be considered in the search for improved esthetic results, whether in dental or facial esthetic treatments.
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Affiliation(s)
- Orlando Motohiro Tanaka
- Department of Orthodontics, School of Life Sciences, Graduate Dentistry Program in Orthodontics, School of Life Sciences, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
- The Center for Advanced Dental Education at Saint Louis University, Louis, MO, USA
| | - Lorenzo Daroit Cavassin
- Department of Orthodontics, School of Life Sciences, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Gil Guilherme Gasparello
- Department of Orthodontics, School of Life Sciences, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Thiago Martins Meira
- Department of Orthodontics, School of Life Sciences, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
- Dentistry School, Bahia State University (UNEB), Guanambi, Bahia, Brazil
| | - Caio Seiti Miyoshi
- Department of Orthodontics, School of Life Sciences, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Giovani Ceron Hartmann
- Department of Orthodontics, School of Life Sciences, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
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Voegeli R, Schoop R, Prestat-Marquis E, Rawlings AV, Shackelford TK, Fink B. Differences between perceived age and chronological age in women: A multi-ethnic and multi-centre study. Int J Cosmet Sci 2021; 43:547-560. [PMID: 34293190 PMCID: PMC9291153 DOI: 10.1111/ics.12727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/20/2021] [Accepted: 07/21/2021] [Indexed: 12/13/2022]
Abstract
Objective Accuracy in assessing age from facial cues is important in social perception given reports of strong negative correlations between perceived age and assessments of health and attractiveness. In a multi‐ethnic and multi‐centre study, we previously documented similar patterns of female facial age assessments across ethnicities, influenced by gender and ethnicity of assessors. Methods Here we extend these findings by examining differences between estimated age from digital portraits and chronological age (Δ age) for 180 women from three age groups (20–34, 35–49, 50–66 years) and five ethnicities (36 images of each ethnicity, assessed for age on a continuous scale by 120 female and male raters of each ethnicity). Results Across ethnicities, Δ age was smallest in French assessors and largest in South African assessors. Numerically, French women were judged oldest and Chinese women youngest relative to chronological age. In younger women, Δ age was larger than in middle‐aged and older women. This effect was particularly evident when considering the interaction of women's age with assessor gender and ethnicity, independently and together, on Δ age. Conclusion Collectively, our findings suggest that accuracy in assessments of female age from digital portraits depends on the chronological age and ethnicity of the photographed women and the ethnicity and gender of the assessor. We discuss the findings concerning ethnic variation in skin pigmentation and visible signs of ageing and comment on implications for cosmetic science.
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Affiliation(s)
| | | | | | | | | | - Bernhard Fink
- Biosocial Science Information, Biedermannsdorf, Austria.,Department of Evolutionary Anthropology, University of Vienna, Vienna, Austria
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Facial metrics generated from manually and automatically placed image landmarks are highly correlated. EVOL HUM BEHAV 2021. [DOI: 10.1016/j.evolhumbehav.2020.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Liao D, Ishii LE, Chen J, Chen LW, Kumar A, Papel ID, Kontis TC, Byrne PJ, Boahene KDO, Ishii M. How Old Do I Look? Exploring the Facial Cues of Age in a Tasked Eye-Tracking Study. Facial Plast Surg Aesthet Med 2020; 22:36-41. [PMID: 32053421 DOI: 10.1089/fpsam.2019.29001.lia] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Importance: This is the first eye-tracking study to use a tasked age estimation paradigm to explore the facial cues of age as seen by casual observers. Objectives: Determine where observers gaze on faces when tasked with estimating an individual's age. Design, Setting, and Participants: This was a prospective controlled experiment, which took place at an academic tertiary referral center. In total, 220 casual observers (80 untasked, 140 tasked) viewed frontal facial images of women while an infrared eye-tracking monitor recorded their eye movements and fixations in real time. Main Outcomes and Measures: Multivariate Hotelling's analysis followed by planned posthypothesis testing was used to compare fixation durations for predefined regions of interest, including the central triangle, upper face, midface, lower face, and neck between tasked and untasked observers. Results: A total of 80 observers (mean age 23.6 years, 53% female) successfully completed the first untasked eye-tracking experiment. A total of 140 observers (mean age 26.1 years, 60% female) successfully completed the second age estimation experiment. On multivariate analysis, there were significant differences in the distribution of attention between observers in the two experiments (T2 = 99.70; F(5,2084) = 19.9012, p < 0.0001). On planned posthypothesis testing, observers attended significantly more to the lower third of the face (0.20 s, p < 0.0001, 95% confidence interval (CI) 0.14-0.27 s) and neck (0.05 s, p = 0.0074, 95% CI 0.01-0.08 s) and less to the upper third of the face (-0.27 s, p < 0.0001, 95% CI -0.40 to -0.14 s) when tasked. There was no significant difference in time spent on the whole face in the two experiments, suggesting that peripheral elements such as hair color or jewelry did not significantly influence gaze patterns. Conclusions and Relevance: Humans form judgments about others every day of their lives, and age perception colors their every interaction. To our knowledge, this study is the first to use eye tracking to investigate facial cues of age. The results showed that when tasked with estimating age, casual observer visual attention was shifted toward the lower face when compared with those who were untasked. These data inform our understanding of facial age perception and potential areas to target for facial rejuvenation. Level of Evidence: NA.
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Affiliation(s)
- David Liao
- Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lisa E Ishii
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jonlin Chen
- Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lena W Chen
- Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Anisha Kumar
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ira D Papel
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Facial Plastic Surgicenter, Ltd, Baltimore, Maryland
| | - Theda C Kontis
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Facial Plastic Surgicenter, Ltd, Baltimore, Maryland
| | - Patrick J Byrne
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University 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 University School of Medicine, Baltimore, Maryland
| | - Masaru Ishii
- Division of Rhinology, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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