Impact of Surgical Rejuvenation on Visual Processing and Character Attribution of Periorbital Aging

Abstract

Background: The perceptual response to aging changes in the periorbital region and the effects of surgical rejuvenation on that response have not been elucidated. The authors examined the reflexive visual response to periorbital aging before and after brow lift and upper blepharoplasty surgery and investigated how observers’ character attributions of the images were affected by the rejuvenative intervention. Methods: Preoperative and postoperative photographs were obtained of patients with brow ptosis and dermatochalasis who underwent brow lift and blepharoplasty. Forty observers examined each image while an infrared eye-tracking camera continuously recorded their eye movements. The observers rated the images with respect to character attributes (attractiveness, trustworthiness, sociability, healthiness, and capability) on a scale of one to seven. Results: Fourteen patients who underwent brow lift and blepharoplasty were identified and studied. The surgical intervention was found to increase observers’ attention to the eye and brow region, while decreasing relative attention to the forehead and lower eyelid areas; increase the two-dimensional surface area of the forehead and eye and brow zones in a manner directly associated with the measured changes in visual attention; and significantly increase the ratings for all five positively valanced character attributes compared with preoperative controls. Conclusions: The authors provide an important combination of explicit and implicit data illustrating how surgical rejuvenation unveils the periorbital region to the observer. This change in pattern of inspection was associated with an improvement in the perception of character.

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

“…17 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.…”

“…Generally, rejuvenation surgery alters where observers look with decreasing time spent inspecting areas of preoperative prominent signs of aging that have been improved by surgery 21 . However, reporting on the reflexive visual response to periorbital aging before and after brow lift and upper blepharoplasty surgery, and investigating how observers’ character attributions of the images are affected by the rejuvenative intervention, Boonipat et al 26 reported increased observers’ attention to the eye and brow region with decreased relative attention to the forehead and lower eyelid areas, contrary to what may have been expected and at odds with findings consistent with the “internal representation of beauty.” The plausible explanation presented by the authors is that the area of change in their patients corresponds to the anticipated look zone of the eyes and that increased surface area of the eye and brow region secondary to surgical rejuvenation increases visual attention.…”

Parents of Children with Cleft Lip Exhibit Heightened Visual Attention to the Perioral Area

“… 20 , 21 In prior work, even natural aging changes of the face have been shown to be associated with a reduction in positively valenced character attributes. 22 To our knowledge, there are no preceding investigations that consider the interplay between observers’ gaze pattern, personal history of the facial change in question, and social attribution. These parameters, and how they interrelate, are important considerations for the surgeon managing a child with a cleft.…”

Impact of Surgical Rejuvenation on Visual Processing and Character Attribution of Faces

“…The lack of statistical significance in this finding may be explained by the fact that the comprehensive package of rejuvenative interventions performed in our study impacted a broad array of the facial lookzones considered, perhaps more so than in the Frautschi protocol where the dominant intervention was a rhytidectomy. Similarly, whereas prior eye-tracking studies focused more narrowly on targets such as cleft lip deformity, 10 nasal dorsal deviation, 24 or periorbital aging, 25 the suite of surgical procedures considered here altered the brow, periorbital region, nasolabial folds, marionette lines, lips, jowls, and cervicomental region. It is reasonable to infer that such an extensive transformation of the face would provoke a holistic change in the pattern of observer visual fixation, countering the likelihood for detection of a prevailing measurable change in any one particular lookzone.…”