The Cost of Facial Deformity

Dey, Jacob K.; Ishii, Lisa E.; Joseph, Andrew; Goines, Jennifer; Byrne, Patrick J.; Boahene, Kofi; Ishii, Masaru

doi:10.1001/jamafacial.2015.2365

Cited by 31 publications

(29 citation statements)

References 27 publications

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“…Facial appearance defines an individual’s identity, and directly influences emotions and social interactions. (40) Therefore, visible scarring can lead to anxiety, poor self-esteem and a decreased quality of life. (41) While satisfaction with facial appearance after surgery is an important outcome, it is often overlooked in dermatologic surgery.…”

Section: Discussionmentioning

confidence: 99%

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FACE-Q Skin Cancer Module for measuring patient-reported outcomes following facial skin cancer surgery

Lee

Klassen

Cano³

et al. 2018

Br J Dermatol

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Section: Discussionmentioning

confidence: 99%

“…(44) Studies have also demonstrated diminished QOL with scarring and the value of reconstruction of facial defects. (6, 40) Therefore, an instrument that measures facial appearance satisfaction and scar outcome is especially applicable to the skin cancer population.…”

Section: Discussionmentioning

confidence: 99%

FACE-Q Skin Cancer Module for measuring patient-reported outcomes following facial skin cancer surgery

Lee

Klassen

Cano³

et al. 2018

Br J Dermatol

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“…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. 8 Within each of these studies that separated facial defects into categories based on defect size and location before reconstructive surgery, a common theme emerged.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

mentioning

confidence: 99%

“…[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.…”

mentioning

confidence: 99%

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Measuring Outcomes of Mohs Defect Reconstruction Using Eye-Tracking Technology

Dey

Ishii

Boahene

et al. 2019

JAMA Facial Plast Surg

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IMPORTANCEObjectively measuring how Mohs defect reconstruction changes casual observer attention has important implications for patients and facial plastic surgeons. OBJECTIVE To use eye-tracking technology to objectively measure the ability of Mohs facial defect reconstruction to normalize facial attention. DESIGN, SETTING, AND PARTICIPANTSThis observational outcomes study was conducted at an academic tertiary referral center from January to June 2016. An eye-tracking system was used to record how 82 casual observers directed attention to photographs of 32 patients with Mohs facial defects of varying sizes and locations before and after reconstruction as well as 16 control faces with no facial defects. Statistical analysis was performed from November 2018 to January 2019. MAIN OUTCOMES AND MEASURESFirst, the attentional distraction caused by facial defects was quantified in milliseconds of gaze time using eye tracking. Second, the eye-tracking data were analyzed using mixed-effects linear regression to assess the association of facial defect reconstruction with normalized facial attention. RESULTSThe 82 casual observers (63 women and 19 men; mean [SD] age, 34 [12] years) viewed control faces in a similar and consistent fashion, with most attention (65%; 95% CI, 62%-69%) directed at the central triangle, which includes the eyes, nose, and mouth. The eyes were the most visually important feature, capturing a mean of 60% (95% CI, 57%-64%) of fixation time within the central triangle and 39% (95% CI, 36%-43%) of total observer attention. The presence of Mohs defects was associated with statistically significant alterations in this pattern of normal facial attention. The larger the defect and the more centrally a defect was located, the more attentional distraction was observed, as measured by increased attention on the defect and decreased attention on the eyes, ranging from 729 (95% CI, 526-931) milliseconds for small peripheral defects to 3693 (95% CI, 3490-3896) milliseconds for large central defects. Reconstructive surgery was associated with improved gaze deviations for all faces and with normalized attention directed to the eyes for all faces except for those with large central defects.CONCLUSIONS AND RELEVANCE Mohs defects are associated with altered facial perception, diverting attention from valuable features such as the eyes. Reconstructive surgery was associated with normalized attentional distraction for many patients with cutaneous Mohs defects. These data are important to patients who want to know how reconstructive surgery could change the way people look at their face. The data also point to the possibility of outcomes prediction based on facial defect size and location before reconstruction. Eye tracking is a valuable research tool for outcomes assessment that lays the foundation for understanding how reconstructive surgery may change perception and normalize facial deformity.

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Societal Value of Surgery for Facial Reanimation

Ishii

Joseph

et al. 2017

JAMA Facial Plast Surg

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IMPORTANCEPatients with facial paralysis are perceived negatively by society in a number of domains. Society's perception of the health utility of varying degrees of facial paralysis and the value society places on reconstructive surgery for facial reanimation need to be quantified.OBJECTIVE To measure health state utility of varying degrees of facial paralysis, willingness to pay (WTP) for a repair, and the subsequent value of facial reanimation surgery as perceived by society. DESIGN, SETTING, AND PARTICIPANTSThis prospective observational study conducted in an academic tertiary referral center evaluated a group of 348 casual observers who viewed images of faces with unilateral facial paralysis of 3 severity levels (low, medium, and high) categorized by House-Brackmann grade. Structural equation modeling was performed to understand associations among health utility metrics, WTP, and facial perception domains. Data were collected from July 16 to September 26, 2015.MAIN OUTCOMES AND MEASURES Observer-rated (1) quality of life (QOL) using established health utility metrics (standard gamble, time trade-off, and a visual analog scale) and ( 2) their WTP for surgical repair. RESULTS Among the 348 observers (248 women [71.3%]; 100 men [28.7%]; mean [SD] age, 29.3 [11.6] years), mixed-effects linear regression showed that WTP increased nonlinearly with increasing severity of paralysis.

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The Cost of Facial Deformity

Cited by 31 publications

References 27 publications

FACE-Q Skin Cancer Module for measuring patient-reported outcomes following facial skin cancer surgery

FACE-Q Skin Cancer Module for measuring patient-reported outcomes following facial skin cancer surgery

Measuring Outcomes of Mohs Defect Reconstruction Using Eye-Tracking Technology

Societal Value of Surgery for Facial Reanimation

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