The impact of facial defects on quality of life as perceived by society and the value society places on facial reconstruction are important outcomes measures. OBJECTIVE To measure the health state utility and dollar value of surgically reconstructing facial defects as perceived by society. DESIGN, SETTING, AND PARTICIPANTS A randomized observational study conducted in an academic tertiary referral center using a socioeconomically diverse group of 200 casual observers. MAIN OUTCOMES AND MEASURES Observers viewed images of faces with defects of varying sizes and locations before and after surgical reconstruction. Observers imagined if the defect in each image were on their own face and rated (1) their health state utility with the defect and (2) how much they would be willing to pay to have the defect surgically repaired to normal (perfect repair). Established health state utility and contingent valuation metrics were used. RESULTS Data from 200 observers were analyzed. Facial defects significantly decreased perceived health state utility with the greatest penalty attributed to large and centrally located defects. Surgical reconstruction of the facial defects increased health state utility to near-normal ranges for all groups except large central defects.

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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]: