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Appearance Is a Function of the Face

Borah, Gregory L. M.D.; Rankin, Marlene K. Ph.D.

Plastic and Reconstructive Surgery: March 2010 - Volume 125 - Issue 3 - p 873-878
doi: 10.1097/PRS.0b013e3181cb613d
Reconstructive: Head and Neck: Original Articles

Background: Increasingly, third-party insurers deny coverage to patients with posttraumatic and congenital facial deformities because these are not seen as “functional.” Recent facial transplants have demonstrated that severely deformed patients are willing to undergo potentially life-threatening surgery in search of a normal physiognomy. Scant quantitative research exists that objectively documents appearance as a primary “function” of the face. This study was designed to establish a population-based definition of the functions of the human face, rank importance of the face among various anatomical areas, and determine the risk value the average person places on a normal appearance.

Methods: Voluntary adult subjects (n = 210) in three states aged 18 to 75 years were recruited using a quota sampling technique. Subjects completed study questionnaires of demography and bias using the Gamble Chance of Death Questionnaire and the Rosenberg Self-Esteem Scale.

Results: The face ranked as the most important anatomical area for functional reconstruction. Appearance was the fifth most important function of the face, after breathing, sight, speech, and eating. Normal facial appearance was rated as very important for one to be a functioning member of American society (p = 0.01) by 49 percent. One in seven subjects (13 percent) would accept a 30 to 45 percent risk of death to obtain a “normal” face.

Conclusions: Normal appearance is a primary function of the face, based on a large, culturally diverse population sample across the lifespan. Normal appearance ranks above smell and expression as a function. Restoration of facial appearance is ranked the most important anatomical area for repair. Normal facial appearance is very important for one to be a functional member of American society.

New Brunswick, N.J.

From the Division of Plastic Surgery, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, and the College of Nursing of Rutgers, The State University of New Jersey.

Received for publication July 30, 2009; accepted September 16, 2009.

Presented at the 80th Annual Scientific Meeting of the American Association of Plastic Surgeons, in Charleston, South Carolina, May 13 through 16, 2001.

Disclosure: This research was supported in part by a grant from the Plastic Surgery Educational Foundation. The authors have no other financial information to disclose.

Gregory L. Borah, M.D.; Division of Plastic Surgery; Robert Wood Johnson Medical School; University of Medicine and Dentistry of New Jersey; 1 Robert Wood Johnson Place, MEB 506; New Brunswick, N.J. 08901;

©2010American Society of Plastic Surgeons