The Use of Eye Tracking Technology in Aesthetic Surgery: Analyzing Changes in Facial Attention Following Surgery

Abstract

Background The ability to quantitatively analyze how we look at a face and determine if this changes following facial surgery should be of interest to the plastic surgeon. Eye tracking technology (ETT) provides the ability to record where observers fixate when viewing a facial image, enabling quantitative data to be obtained comparing pre- and postoperative changes. Objectives The authors sought to investigate ETT as a novel outcome assessment tool, determining if facial rejuvenation surgery shifts attention away from the prominent signs of aging, and if so, where this attention shifts. Methods Twenty-five volunteers viewed 32 randomized frontal, oblique, and lateral images of 11 patients pre- and post-facelift. An eye movement monitoring system recorded the observer’s eye position, net dwell time, fixation count, fixation time, and revisits into predefined areas of interest. Data were grouped and analyzed by angle and areas of interest. Paired t tests were employed to detect significant differences in pre- and post-images. Results On frontal images, less dwell time, fixations, and revisits were noted on the bottom third, forehead, perioral region, and neck (P < 0.05). On the lateral view, less visual attention was given to the neck, upper third, and perioral region, with more time in the cheek, nose, and middle third (P < 0.05). On oblique images, less attention was given to the neck and upper lid with more aimed at the middle third of the face (P < 0.05). Conclusions ETT provides quantitative data post-facial rejuvenation. Facial aesthetic surgery does alter where observers look when viewing a face, decreasing the time spent inspecting the prominent signs of aging.

Use of Micro Botulinum Toxin for a Face-lifting Effect: A Systematic Review

“…13 While studies have suggested that skin tone does not appear to influence the outcome of such computer analysis, 27 given the discordance with physician clinical assessments as shown in this study, perhaps, it is time to consider alternatives such as artificial intelligence, 28 patient-reported outcomes (e.g. FACE-Q surveys), 28 and even eye tracking technology 29 for more objective and valid (i.e. by the patients) assessments.…”

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.…”

“…Interpretation of observers’ visual gaze when looking at images of patients’ prefacial and postfacial rejuvenation is also not easy nor straightforward. 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.…”

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

“…Rather, it focused primarily on the extent of observer experience in cosmetic surgery on respective gaze distribution across the face. More recently, Frautschi et al 17 used eye tracking with 25 naïve subjects observing preoperative and postoperative images of 11 patients undergoing face lift. Confounding the interpretation of their study was the fact that the 11 patients also underwent a total of 28 concurrent adjunctive facial aesthetic procedures (including two brow lifts and four upper blepharoplasties).…”

“…Previous studies questioned whether different types of standing anatomic aberrations attract visual attention, and repeatedly confirmed that they do, but the capacity of facial reconstruction to alter those eye-tracking patterns has not been evaluated extensively. The study by Frautschi et al 17 evaluated the effect of rhytidectomy, but the area of deformity in question was primarily the neck and jawline, which are not normally high-attention regions when a face is observed from the frontal view. That is, rhytidectomy reduces deformity in a relatively lower attraction zone and encourages any distracted attention to return to the normal zone of maximal concentration (the eyes).…”