Assessing Gaze Patterns in Common Cosmetic Procedures With Eye-Tracking Technology

Abstract

Background Understanding the salient features that draw focus when assessing aesthetics is important for maximizing perceived outcomes. Eye-tracking technology provides an unbiased method for determining the features that draw attention when evaluating aesthetic plastic surgery. This study aimed to characterize viewing patterns of plastic surgery patients and laypeople when assessing facial cosmetic procedure images. Methods Twenty women who previously underwent cosmetic procedures and twenty women without a history of cosmetic procedures were shown sixteen pairs of preprocedure and postprocedure images of patients who underwent laser resurfacing or lip augmentation. Image pairs were randomized to whether preprocedural or postprocedural images came first. Participants viewed each image until they decided upon an aesthetic rating (scored 1–10), while an eye-tracking device recorded participants' gaze. Results The patient group's average ratings were 8.2% higher for preprocedural images and 13.3% higher for postprocedural images (P < 0.05 for both). The patient group spent 20.4% less time viewing images but spent proportionally more time evaluating the relevant features of each procedure (41.7% vs 23.3%, P < 0.01), such as the vermillion border of the upper lip, labial commissure, or periorbital region (P < 0.05 for each). For both groups, the most common site of first fixation was the nose for laser resurfacing images (26.6%) and the labial commissure for lip augmentation images (37.7%). Both groups spent more time fixated on nasolabial folds, marionette lines, and the periorbital region when viewing pre–laser resurfacing images than postprocedural images. Overall, each group had similar viewing patterns for time to first fixation on and frequency of fixations for a particular feature. Conclusions Women who previously underwent cosmetic procedures view postprocedural images more favorably and require less time to assess images, likely related to familiarity with aesthetic procedures. These women spend more time fixated on relevant features, such as the vermillion border of the upper lip, the labial commissure, and the periorbital region, than the control group. Notably, each group spent less time focused on regions associated with wrinkles, such as the marionette and periorbital areas in post–laser resurfacing images, suggesting that the procedure reduces attention-drawing features in these areas.

A Narrative Review of Eye-Tracking Assessment of Esthetic Endpoints in Plastic, Reconstructive, and Craniofacial Surgery

“…51 Likewise, decreased time focused on post-laser resurfacing or lip augmentation procedure regions associated with preintervention wrinkles is suggestive that the procedure has resulted in a net esthetic improvement as would be predicted by the "internal representation of beauty" theory. 27 Interestingly, this is in contradistinction to what may be expected when comparing surgical to nonsurgical rhinoplasty. Overall time of fixation of lateral images of surgical rhinoplasty and number of fixations have been reported to increase significantly despite marked improvement in nasal esthetic profile compared with nonsurgical intervention.…”

“…18,19 Eleven studies involved facial esthetic surgery, including prominent ears, 20 rhytidectomy, 21,22 rhinoplasty, 23,24 periorbital rejuvenation, 25,26 and minimally invasive procedures. 27,28 Two studies were designed to test visual gaze of observers looking at facial images. 29,30 Eye-tracking application to breast surgery was reported in only 4 publications.…”

“…Two additional studies analyzed visual gaze patterns after open neck surgery compared with no neck scars 18,19 . Eleven studies involved facial esthetic surgery, including prominent ears, 20 rhytidectomy, 21,22 rhinoplasty, 23,24 periorbital rejuvenation, 25,26 and minimally invasive procedures 27,28 . Two studies were designed to test visual gaze of observers looking at facial images 29,30 …”

The Use of Eye-tracking Technology in Cleft Lip: A Literature Review

“…Full-text screening of the remaining 21 publications resulted in the exclusion of a further five. Four studies [10][11][12][13] used eye-tracking to assess conditions or outcomes unrelated to CL+/−P, and one 14 used eye-tracking in CL+/−P but did not report gaze outcomes in a format allowing comparison to other publications (did not report using AOIs). This resulted in a total of 16 publications that used a form of eye-tracking in the field of CL+/−P.…”

“…It has been used in various subspecialities including cosmetic surgery, facial reconstructive surgery (ear, nose, cleft), and breast reconstructive surgery. [7][8][9][10] There has been significant interest in the use of eye-tracking for the assessment of appearance outcomes in cleft surgery as this is the subspeciality within plastic surgery with the greatest number of previous eye-tracking publications. 6 This may indicate that there is a lack of robust appearance measurement techniques and the ongoing interest in finding an objective method of assessment.…”