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

Abstract

Objectives:

Measure the impact of facial lesion reconstruction on observer-graded attractiveness and measures of negative facial perception.

Methods:

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

Results:

Facial lesions decreased attractiveness –2.26 [–2.45, –2.08] on a 10-point scale. Mixed effects linear regression modeling showed this attractiveness penalty varied with lesion size and location, with large and central lesions generating the greatest penalty. Reconstructive surgery increased attractiveness 1.33 [1.18, 1.47], an improvement that also varied with size and location, restoring some lesion 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 DIBS factor score, representing negative facial perception. The DIBS regression showed lesion faces have a 1.5 standard deviation increase in negative perception [DIBS: 1.69 (1.61,1.77)], which decreased by a similar magnitude after surgery [DIBS: –1.44 (–1.49, –1.38)]. These findings also varied with lesion size and location.

Conclusions:

Surgical reconstruction of facial lesions increased attractiveness and decreased negative social facial perception, an impact that varied with lesion size and location. This new social perception evidence, when combined with patient and expert perception data, will inform our evidence-based soft tissue reconstructive algorithm.