INTRODUCTION: Satisfaction is an important outcome for cosmetic plastic surgery procedures and hinges upon improvement of esthetics. Understanding the salient features that draw focus when assessing esthetics is important for maximizing perceived outcomes. Eye-tracking technology provides an unbiased method for determining the features that draw attention when evaluating esthetic plastic surgery. This study aimed to characterize viewing patterns of plastic surgery patients and laypeople when assessing pre- and post-abdominoplasty images.
METHODS: Twenty women who previously underwent cosmetic procedures and 20 women without a prior history of cosmetic procedures were shown 8 pairs of pre- and post-abdominoplasty images in both AP and lateral views (32 images total). Image pairs were randomized to whether pre- or postprocedural images came first. Participants viewed each image until they decided upon an esthetic rating (scored 1–10), whereas an eye-tracking device (Tobii X2-60, estimated accuracy: 6 mm; Tobii Inc.) recorded participants’ gaze. Groups were compared using 2-tailed, independent t tests.
RESULTS: The average improvement in rating between pre- and postprocedural images was 30.4% higher in the patient group than in the lay group (P < 0.05). The patient group spent 22.6% less time evaluating the images on average (P < 0.05); however, the patient group spent proportionally more time fixated on features of interest (20.4% of their time spent viewing images on average versus 10.0%; P < 0.001). Specifically, the patient group spent proportionally more time fixated on the umbilicus (25.6% versus 11.6%; P < 0.001) and scar line for AP views (13.2% versus 5.1%; P < 0.001) and more time fixated on the abdominal curvature for lateral views (7.6% versus 3.6%; P < 0.001). There was no significant difference between the groups in terms of fixation on the flanks or back curvature. Both groups tended to fixate on the umbilicus first for AP views (63.0% of all samples) and the abdominal curvature for lateral views (35.5% of all samples). Overall, each group had similar viewing patterns in terms of the time it took to first fixate on a particular feature and number of times they fixated on each feature. There was no correlation between the time a participant spent viewing an image and the esthetic rating the participant gave it.
CONCLUSIONS: Eye tracking enables determination of features which draw gaze and attention and may be used to help assess surgical outcomes. With this technology, we found that women who previously underwent cosmetic procedures view postprocedural images more favorably and require less time to assess images. However, these women were more targeted viewers, spending proportionally more time fixated on key features, such as the umbilicus, scar line, and abdominal curvature, than women who have not undergone cosmetic plastic surgery. Finally, the umbilicus was the most heavily fixated upon feature for both groups in our study, suggesting that it strongly draws focus and therefore is a structure surgeons should dedicate increased care and attention on during abdominoplasty procedures.