Measurement of the Quality of Facial Lesion Reconstruction With Observer-Graded Affect Display

Abstract

IMPORTANCEThe impact of facial reconstructive surgery on improving affect display for patients with facial lesions is incompletely understood.OBJECTIVES To measure the impact of surgically reconstructing facial lesions on observer graded affect display. DESIGN, SETTING, AND PARTICIPANTSThis was a prospective randomized controlled experiment at an academic tertiary referral center; 120 naïve observers completed one of 4 surveys of 20 images of faces. MAIN OUTCOMES AND MEASURESA total of 80 different images of faces were used: 32 faces with lesions preoperatively and postoperatively, and 16 normal faces. The 32 lesion faces were categorized into 4 categories of lesion with 8 faces in each category: small peripheral, small central, large peripheral, and large central. Participants viewed 20 images of faces: 8 preoperative, 8 postoperative, and 4 normal. Observers rated faces by selecting all terms that applied from 8 affects of the Derogatis Affects Balance Scale (DABS), the Ekman scale's 6 basic emotions, and a neutral term. Latent class analysis and regression were used to determine number and characteristics of affect classes and significance of covariates: operation status, size, and location. Postoperative faces were compared with normal faces via bootstrap analysis to determine statistically significant differences in affect display. Analysis took place in August 2014 and was verified in December 2015.RESULTS A total of 120 observers rated 80 facial images via 4 surveys. The mean (SD) age of the observers was 32.2 (13.5) years (range, 18-72 years). Both scales collapsed into 3 latent classes: positive, neutral, and negative for normal faces and faces with lesions. Using the DABS, faces with lesions preoperatively were more likely to be in the negative affect class (small peripheral [SP]:

Measuring Outcomes of Mohs Defect Reconstruction Using Eye-Tracking Technology

“…10 Reconstruction of facial defects improves perceived attractiveness, 12 decrease negative facial perception, 12 and normalize patient affect display. 14 Casual observers perceive individuals with facial defects as having a lower health utility and quality of life, a penalty that is normalized in many cases after reconstruction. 13 Furthermore, members of society are less likely to engage and have a conversation with people with facial defects, a social penalty that improved after reconstructive surgery.…”

“…There are numerous outcome measures described in the facial plastic and reconstructive surgery literature. These can be organized by method (subjective [8][9][10][11][12][13][14][15][16][17][18] or objective [19][20][21][22][23][24][25] ) and perspective (patient, [16][17][18] surgeon or expert, 15,24,25 or society [8][9][10][11][12][13][14][19][20][21][22][23] ). Each of these 6 classes (subjective patient, objective patient, subjective expert, objective expert, subjective society, and objective society) of outcome metrics has utility in the complex assessment of facial deformities and their reconstruction.…”

“…[4][5][6][7][8] Studies have shown that individuals with cutaneous facial defects experience a social penalty and are subject to negative facial perception. [8][9][10][12][13][14] Furthermore, an important measure of successful reconstructive surgery is restoration of perceived normalcy. Eye tracking is a technique that allows us to objectively measure how facial deformities and their reconstruction change the way people direct attention to a face.…”

Role of Camouflage in Management of Facial Trauma Deformities

“…Traumatic deformities resulting in abnormal concavities and convexities of the face often draw unwanted attention and can be misperceived by others, generating emotional distress. 4 Soft tissue contouring defects may be due to tissue lost/contraction, malposition due to disruption of soft tissue suspension, or fat involution. The senior author (T.T.T.)…”

Objectively measuring social attention of thyroid neck scars and transoral surgery using eye tracking

“…20,21,23,24 Further, these eye movement aberrations correlated with changes in observer perception in the domains of attractiveness, QOL, and affect. 23,[25][26][27][28][29] We can correlate these findings to thyroid neck scars, where understanding the basis for why observers perceive patients with thyroid neck scars differently on social metrics of attractiveness, QOL, and overall neck appearance requires a clearer understanding of where observers direct their attention when making these assessments.…”