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Where Do We Look? Assessing Gaze Patterns in Cosmetic Facelift Surgery with Eye Tracking Technology

Cai, Lawrence Z. MD; Kwong, Jeffrey W. BS; Azad, Amee D. BA; Kahn, David MD; Lee, Gordon K. MD; Nazerali, Rahim S. MD

Plastic and Reconstructive Surgery: April 9, 2019 - Volume PRS Online First - Issue - p
doi: 10.1097/PRS.0000000000005700
Original Article: PDF Only
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Purpose: Aesthetics plays a central role in determining success in plastic surgery. Understanding perceptions of favorable aesthetics is critical to ensure patient satisfaction. Eye-tracking technology offers an objective way to evaluate attention and understand how viewers direct their focus in patients who undergo cosmetic facelift procedures.

Methods: Thirty-six subjects ranging from layperson to attending plastic surgeon viewed 15 sets of photos before and after patients underwent an elective facelift procedure. They were instructed to evaluate the aesthetic quality on a Likert scale, while eye-tracking equipment tracked their gaze and analyzed their distribution of attention.

Results: Post-operative images showed a Likert score improvement of 0.51±0.26, with the greatest difference in attending cosmetic plastic surgeons (1.36±0.22; p<0.05). The nose was the most common first fixation location (31% of first fixations) and the most viewed area (16±3% of fixation time) for all subjects. Experienced subjects spent less time in non-relevant areas (30±11% for attending cosmetic plastic surgeons and 37±10% for attending non-cosmetic plastic surgeons) compared to less experienced subjects (50±15% for laypersons).

Conclusions: This study demonstrates that viewers with greater experience in cosmetic surgery focus quickly on the cheeks, chin, and neck and have evenly distributed gaze across the entire face. These results suggest that laypersons’ gaze are drawn to the center of the face – due to both unfamiliarity with the facelift procedure and the natural tendency to look at the central face – while attending plastic surgeons exhibit holistic gaze patterns and are more aware of the impact of the procedure.

Division of Plastic and Reconstructive Surgery, Stanford University, Palo Alto

Stanford School of Medicine, Palo Alto

Stanford School of Medicine, Palo Alto

Division of Plastic and Reconstructive Surgery, Stanford University, Palo Alto

Division of Plastic and Reconstructive Surgery, Stanford University, Palo Alto

Division of Plastic and Reconstructive Surgery, Stanford University, Palo Alto

Meetings at which paper has been presented: None

Sources of support:Stanford School of Medicine – MedScholars Research Program

Possible conflicts of interest: None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript.

Acknowledgements: We thank the Tobii Group for the generous use of their eye-tracking hardware and software for this study.

Corresponding Author: Name: Rahim Nazerali, Address: 770 Welch Road Suite 400, Stanford, CA 94304, Phone: 650-723-5824, Fax: 650-725-6605, Email: rahimn@stanford.edu

©2019American Society of Plastic Surgeons