Impact of facial defect reconstruction on attractiveness and negative facial perception

Objectives/hypothesis: Measure the impact of facial defect reconstruction on observer-graded attractiveness and negative facial perception.

Study design: Prospective, randomized, controlled experiment.

Methods: One hundred twenty casual observers viewed images of faces with defects of varying sizes and locations before and after reconstruction as well as normal comparison faces. Observers rated attractiveness, defect severity, and how disfiguring, bothersome, and important to repair they considered each face.

Results: Facial defects decreased attractiveness -2.26 (95% confidence interval [CI]: -2.45, -2.08) on a 10-point scale. Mixed effects linear regression showed this attractiveness penalty varied with defect size and location, with large and central defects generating the greatest penalty. Reconstructive surgery increased attractiveness 1.33 (95% CI: 1.18, 1.47), an improvement dependent upon size and location, restoring some defect categories to near normal ranges of attractiveness. Iterated principal factor analysis indicated the disfiguring, important to repair, bothersome, and severity variables were highly correlated and measured a common domain; thus, they were combined to create the disfigured, important to repair, bothersome, severity (DIBS) factor score, representing negative facial perception. The DIBS regression showed defect faces have a 1.5 standard deviation increase in negative perception (DIBS: 1.69, 95% CI: 1.61, 1.77) compared to normal faces, which decreased by a similar magnitude after surgery (DIBS: -1.44, 95% CI: -1.49, -1.38). These findings varied with defect size and location.

Conclusions: Surgical reconstruction of facial defects increased attractiveness and decreased negative social facial perception, an impact that varied with defect size and location. These new social perception data add to the evidence base demonstrating the value of high-quality reconstructive surgery.

Level of evidence: NA.