The Social Penalty of Facial Lesions

Abstract

IMPORTANCE To date, there have been no studies attempting to measure the multidimensional impact of facial lesions, before and after reconstruction, on social conversation. OBJECTIVE To measure the direct social impact of facial lesions before and after surgical reconstruction. DESIGN, SETTING, AND PARTICIPANTS Prospective randomized controlled experiment at an academic tertiary referral center. One hundred twenty casual observers viewed images of faces with lesions of varying sizes and locations before and after reconstruction as well as faces without lesions (normal faces) for comparison. MAIN OUTCOMES AND MEASURESObservers rated faces using a battery of metrics, including how comfortable they would be having a conversation with the participant in each facial image. The conversation questions were answered on a scale from 0 to 100, where the higher the score, the more comfortable the observer would be conversing with the subject. RESULTSThe mean (SD) conversation score for participants with normal faces was 85.02 (17.95) of 100 points. Facial lesions had a negative effect (or, a penalty) on conversation (61.63 [29.50]). Structural equation modeling showed this conversation penalty varied with lesion size and location, with large and central lesions generating the greatest penalty. Reconstructive surgery increased observers' comfort and willingness to converse with individuals with facial lesion by an average of 19.83 (95% CI,, an improvement that also varied with preoperative lesion size and location. Planned hypothesis testing showed that reconstructive surgery normalized observer comfort in communicating with people with small peripheral, small central, and large peripheral lesions. However, substantial discomfort communicating with patients with large central lesions remained after surgery. Observer-rated facial attractiveness, affect, and perceived quality of life also influenced this social communication measure. CONCLUSIONS AND RELEVANCE Facial lesions induce a significant social penalty as rated by the casual observer. Specifically, observers are less comfortable communicating with people who have facial lesions. Surgical reconstruction of facial lesions increased observers' comfort in conversing with people with facial lesions, an impact that varied with lesion size and location.LEVEL OF EVIDENCE NA.

Measuring Outcomes of Mohs Defect Reconstruction Using Eye-Tracking Technology

“…Given the importance of facial appearance and function in the formation of one's self-esteem, quality of life, and socialization, patients are often concerned about how these defects and their reconstruction affect their appearance and how they are perceived by others. [4][5][6][7][8] Patients want reassurance that, after reconstructive surgery, people will no longer stare at their defect. As such, assessing outcomes of facial plastic and reconstructive procedures, while challenging, is also critically important, allowing us to document benefit, identify limitations, drive innovation, and ultimately improve patient care.…”

“…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.…”

“…26 Assessing outcomes from the perspective of the casual observer or society is critical because patient self-perception, psychosocial health, and quality of life are markedly influenced by how others perceive their face and facial disfigurements. [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.…”

“…[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.…”

Use of Biologic Agents for Lip and Cheek Reconstruction

“…The lips are among the first facial structures people notice in interpersonal conversations with minor defects and distortions being easily noticeable to the average person. 16 17 18 In addition to their aesthetic importance, the lips manipulate oral competence which in turn allows the patient to eat, drink, and produce intelligible speech. 19 Additionally, the lips are also essential components of nonverbal communication as they play a pivotal role in the expression of emotion.…”