Jacob K. Dey

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

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

Seeing is believing: Objectively evaluating the impact of facial reanimation surgery on social perception

Objectively measure the ability of facial reanimation surgery to normalize the appearance of facial paralysis using eye‐tracking technology.

Facial reanimation surgery restores affect display.

Objective Assess the ability of facial reanimation surgery to restore affect display in patients with severe facial paralysis. Study Design Survey of healthy observers’ perception of change in facial visage from preoperative to postoperative state. Setting Academic tertiary referral center. Main Outcome Measures Observer graded affect display. Methods Ninety naive observers completed a survey with pictures of paralyzed faces, smiling and in repose, before and after surgery, as well as normal comparison faces. Observers characterized affect display of each face coded in primary affects from the Derogatis Affects Balance Scale. Results were analyzed with latent class analysis and regression using a three-class model. Results Preoperatively, paralyzed faces in repose were most likely to be considered negative (56.0%), then neutral (41.3%) and positive (2.7%). In this same cohort of patients in repose, reanimation surgery restored affect display to normal levels: decreasing negative classification (18.9%) and increasing neutral (53.4%) and positive (27.7%) classification. Hypothesis testing revealed no statistically significant differences in the mean classification probabilities for postoperative faces in repose versus normal faces in repose. The same analysis was performed for smiling faces, which showed marked improvement with reanimation surgery: decreasing negative (45.6%–11.7%) and increasing positive (26.2%–60.0%) classification. Despite this improvement, there were statistically significant differences in classification of postoperative smiling faces versus normal smiling faces. Conclusion Facial reanimation surgery was associated with normalized affect display for faces in repose and improved affect display for smiling faces. These results provide evidence that facial reanimation improves the facial expression of emotion. Further assessment in additional contexts will help better characterize the ability of facial reanimation to mitigate the psychosocial burden associated with facial paralysis.

Association Among Facial Paralysis, Depression, and Quality of Life in Facial Plastic Surgery Patients

Importance Though anecdotally linked, few studies have investigated the impact of facial paralysis on depression and quality of life (QOL). Objective To measure the association between depression, QOL, and facial paralysis in patients seeking treatment at a facial plastic surgery clinic. Design, Setting, Participants Data were prospectively collected for patients with all-cause facial paralysis and control patients initially presenting to a facial plastic surgery clinic from 2013 to 2015. The control group included a heterogeneous patient population presenting to facial plastic surgery clinic for evaluation. Patients who had prior facial reanimation surgery or missing demographic and psychometric data were excluded from analysis. Main Outcomes and Measures Demographics, facial paralysis etiology, facial paralysis severity (graded on the House-Brackmann scale), Beck depression inventory, and QOL scores in both groups were examined. Potential confounders, including self-reported attractiveness and mood, were collected and analyzed. Self-reported scores were measured using a 0 to 100 visual analog scale. Results There was a total of 263 patients (mean age, 48.8 years; 66.9% were female) were analyzed. There were 175 control patients and 88 patients with facial paralysis. Sex distributions were not significantly different between the facial paralysis and control groups. Patients with facial paralysis had significantly higher depression, lower self-reported attractiveness, lower mood, and lower QOL scores. Overall, 37 patients with facial paralysis (42.1%) screened positive for depression, with the greatest likelihood in patients with House-Brackmann grade 3 or greater (odds ratio, 10.8; 95% CI, 5.13-22.75) compared with 13 control patients (8.1%) (P < .001). In multivariate regression, facial paralysis and female sex were significantly associated with higher depression scores (constant, 2.08 [95% CI, 0.77-3.39]; facial paralysis effect, 5.98 [95% CI, 4.38-7.58]; female effect, 1.95 [95% CI, 0.65-3.25]). Facial paralysis was associated with lower QOL scores (constant, 81.62 [95% CI, 78.98-84.25]; facial paralysis effect, −16.06 [95% CI, −20.50 to −11.62]). Conclusions and Relevance For treatment-seeking patients, facial paralysis was significantly associated with increased depression and worse QOL scores. In addition, female sex was significantly associated with increased depression scores. Moreover, patients with a greater severity of facial paralysis were more likely to screen positive for depression. Clinicians initially evaluating patients should consider the psychological impact of facial paralysis to optimize care. Level of Evidence 2.

The social distraction of facial paralysis: Objective measurement of social attention using eye-tracking

To measure the attentional distraction to the facial paralysis deformity using eye‐tracking, and to distinguish between attention paid to the upper and lower facial divisions in patients with complete paralysis. We hypothesized that features affected by the paralysis deformity would distract the casual observer, leading to an altered pattern of facial attention as compared to normals.

The Cost of Facial Deformity: A Health Utility and Valuation Study

IMPORTANCE 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. Participants were willing to pay an average of

Facial Lesions Negatively Impact Affect Display

1170 (95% CI,

Impact of facial defect reconstruction on attractiveness and negative facial perception

767-

Multifactor Influences of Shared Decision-Making in Acoustic Neuroma Treatment.

1572) to repair a de novo small peripheral defect; they were willing to pay

Evidence-Based Soft-Tissue Reconstruction: Incorporating Lessons Learned from Social Perception

4274 more than the average (95% CI,