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Changing perception: Facial reanimation surgery improves attractiveness and decreases negative facial perception

Authors

  • Jacob K. Dey BS,

    1. Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, U.S.A
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  • Masaru Ishii MD, PhD,

    1. Division of Rhinology, Johns Hopkins School of Medicine, Baltimore, Maryland, U.S.A
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  • Kofi D. O. Boahene MD,

    1. Division of Facial Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, U.S.A
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  • Patrick J. Byrne MD,

    1. Division of Facial Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, U.S.A
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  • Lisa E. Ishii MD, MHS

    Corresponding author
    1. Division of Facial Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, U.S.A
    • Send correspondence to Lisa E. Ishii, MD, Assistant Professor, Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD 21287. E-mail: learnes2@jhmi.edu

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  • The authors have no funding, financial relationships, or conflicts of interest to disclose.

Abstract

Objectives/Hypothesis

Determine the effect of facial reanimation surgery on observer-graded attractiveness and negative facial perception of patients with facial paralysis.

Study Design

Randomized controlled experiment.

Methods

Ninety observers viewed images of paralyzed faces, smiling and in repose, before and after reanimation surgery, as well as normal comparison faces. Observers rated the attractiveness of each face and characterized the paralyzed faces by rating severity, disfigured/bothersome, and importance to repair. Iterated factor analysis indicated these highly correlated variables measure a common domain, so they were combined to create the disfigured, important to repair, bothersome, severity (DIBS) factor score. Mixed effects linear regression determined the effect of facial reanimation surgery on attractiveness and DIBS score.

Results

Facial paralysis induces an attractiveness penalty of 2.51 on a 10-point scale for faces in repose and 3.38 for smiling faces. Mixed effects linear regression showed that reanimation surgery improved attractiveness for faces both in repose and smiling by 0.84 (95% confidence interval [CI]: 0.67, 1.01) and 1.24 (95% CI: 1.07, 1.42) respectively. Planned hypothesis tests confirmed statistically significant differences in attractiveness ratings between postoperative and normal faces, indicating attractiveness was not completely normalized. Regression analysis also showed that reanimation surgery decreased DIBS by 0.807 (95% CI: 0.704, 0.911) for faces in repose and 0.989 (95% CI: 0.886, 1.093), an entire standard deviation, for smiling faces.

Conclusions

Facial reanimation surgery increases attractiveness and decreases negative facial perception of patients with facial paralysis. These data emphasize the need to optimize reanimation surgery to restore not only function, but also symmetry and cosmesis to improve facial perception and patient quality of life. Laryngoscope, 124:84–90, 2014

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