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Where Do We Look? Assessing Gaze Patterns in Cosmetic Face-Lift Surgery with Eye Tracking Technology

Cai, Lawrence Z. M.D.; Kwong, Jeffrey W. B.S.; Azad, Amee D. B.A.; Kahn, David M.D.; Lee, Gordon K. M.D.; Nazerali, Rahim S. M.D., M.H.S.

Plastic and Reconstructive Surgery: July 2019 - Volume 144 - Issue 1 - p 63-70
doi: 10.1097/PRS.0000000000005700
Cosmetic: Original Articles

Background: 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 of evaluating attention and understanding how viewers direct their focus on patients who undergo cosmetic face-lift procedures.

Methods: Thirty-six subjects ranging from layperson to attending plastic surgeon viewed 15 sets of photographs before and after patients underwent an elective face-lift 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: Postoperative 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 percent of first fixations) and the most viewed area (16 ± 3 percent of fixation time) for all subjects. Experienced subjects spent less time in nonrelevant areas (30 ± 11 percent for attending cosmetic plastic surgeons and 37 ± 10 percent for attending noncosmetic plastic surgeons) compared with less experienced subjects (50 ± 15 percent 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 a layperson’s gaze is drawn to the center of the face (because of both unfamiliarity with the face-lift procedure and the natural tendency to look at the central face), whereas attending plastic surgeons exhibit holistic gaze patterns and are more aware of the impact of the procedure.

Palo Alto, Calif.

From the Division of Plastic and Reconstructive Surgery, Stanford University, and Stanford School of Medicine.

Received for publication June 15, 2018; accepted December 20, 2018.

Disclosure:None of the authors has a financial interest in any of the products or devices mentioned in this article.

Rahim S. Nazerali, M.D., M.H.S., 770 Welch Road, Suite 400, Stanford, Calif. 94304,

Copyright © 2019 by the American Society of Plastic Surgeons