The Effect of Cleft Orthognathic and Nasal Reconstruction on Perceived Social Traits

The Evolution of Aesthetic Medicine: Exploring the Intersection of Social Psychology, Technology, and Aesthetic Medicine

A wealth of information can be garnered from the face, such as current emotional state, perceived overall health, personality traits, and even attributed capabilities. It is well understood within aesthetic medicine that minimally invasive treatments positively influence how a patient feels about themselves from an emotional and physical standpoint; however, a growing body of literature suggests that facial aesthetic treatments can also impact how an individual is perceived by others. First impressions, which are formed within milliseconds of viewing a new face, allow us to intuit information about the person and anticipate their intentions. Multiple theories aim to explain why and how these initial social impressions are formed from relatively simple visual cues, and increasing evidence suggests that augmentation of facial appearance influences how others form first impressions. In this article, we discuss theories underlying the importance of first impressions and how minimally invasive aesthetic treatments can affect first impressions and social attributions. We also discuss how advancements in technology can enhance consultations and how technology may expand the world of aesthetic medicine to patients who had not previously considered engaging with aesthetic treatments.

Level of Evidence 5 Diagnostic

A Cross-Sectional Study Examining Andrews' Analysis in Caucasian and African American Subjects

BACKGROUND

Andrews' analysis is a commonly utilized instrument to aid in esthetic positioning of the anteroposterior position of the maxillomandibular complex; however, there is limited data regarding use in non-Caucasian subjects.

PURPOSE

The purpose of this study was to document laypersons preferences of anteroposterior position of the maxillomandibular complex in relation to Andrews' lateral profile analysis in African American (AA) and Caucasian subjects.

STUDY DESIGN, SETTING, SAMPLE

A cross-sectional study was implemented to evaluate the esthetics of AA and Caucasian subjects. Photographs were taken and simulated with anteroposterior maxillomandibular complex positioning in varying relationships to Andrews' goal anterior line limit. A survey was then designed to select the preferred simulation of the facial profile of each subject.

INDEPENDENT VARIABLE

The independent variable was the race of the study subjects.

MAIN OUTCOME VARIABLE

The main outcome was the layperson's preferred lateral facial profile for each subject.

COVARIATES

The covariates included age, race, sex, education level, income, of the laypersons.

ANALYSES

A proportion test was used to decide which profile was preferred. Logistic regression analyses were conducted to assess the association between the preference and respondent demographics. P < .05 was considered significant.

RESULTS

A total of 264 surveys were distributed, and 250 complete surveys were utilized (response rate = 95%). Respondents were majority male (51.2%), aged 35-44 (37.2%), college-educated (57.2%), earning between $20,000 and $50,000 annually (44%), and identified as Caucasian (77.2%). For the female subjects, the respondents preferred +4 and + 6 mm anterior to goal anterior line limit with 54.2% for the Caucasian and 65.9% for the AA subjects (difference = 11.7%; 95% CI:2.7 to 20.7%; P = .008). For the males, 47.4% of the respondents chose 0 mm and +2 mm for the AA subject, while only 24.9% preferred +2 mm for the Caucasian male (difference = 22.5%; 95% CI: 13.8 to 31.1%; P < .0001). Respondent demographics were not found to influence selection.

CONCLUSION AND RELEVANCE

The preferred facial profile as judged by laypersons differs between Caucasian and AA subjects when defined through Andrews' analysis.

Validation of Andrews Analysis in the Virtual Environment

BACKGROUND

Andrews analysis is a tool to establish the aesthetic anteroposterior position of the maxilla. Andrews analysis has not been evaluated through computer-aided surgical simulation (CASS).

PURPOSE

The purpose of this study was to evaluate the accuracy of Andrews profile analysis when performed in the virtual environment.

STUDY DESIGN, SETTING, SAMPLE

A retrospective cohort study was implemented with consecutive patients undergoing orthognathic surgery between February 2020 and February 2022 at the University of Alabama, Birmingham. Traditional Andrews analysis with lateral smiling photographs were taken during the presurgical appointment in adjusted natural head position (aNHP). The standard cone-beam CT obtained for CASS and archived on the KLS Martin (Jacksonville, Florida) database was accessed for retrospective measurement. Lateral facial photographs in aNHP were imported into the virtual environment and the three dimensional (3D) composite model was then oriented into aNHP. The software engineer, blinded to the traditional measurements, then performed the Andrews analysis in the virtual environment by placing a vertical glabella line on the 3D composite model in aNHP. The linear horizontal distance of the maxillary central incisor perpendicular to the vertical glabella line was recorded.

PREDICTOR/EXPOSURE/INDEPENDENT VARIABLE

Method of Andrews analysis measurement (traditional photographic evaluation vs CASS) MAIN OUTCOME VARIABLE: Linear Andrews analysis measurement.

COVARIATES

Additional covariates evaluated were sex, age at surgery, and dentofacial deformity diagnosis.

ANALYSES

Descriptive statistics were computed to compare photographic analysis versus CASS analysis. A P value of <.05 was considered statistically significant.

RESULTS

The average age was 25.7 years old and 54% of patients were female. For the photographic analysis, the mean incisor-goal anterior limit line distance was -0.44 ± 7.12 mm (95% CI, -1.13 to 0.37 mm; P = .46). For the virtual analysis, the mean incisor-goal anterior limit line distance was 0.13 ± 7.21 (95% CI, -0.004 to 0.30; P = .89). The Pearson correlation coefficients between the photograph and 3D analysis were very strong (0.93). The root mean square deviation between the photographic and 3D analysis cohorts was 2.7 mm.

CONCLUSION AND RELEVANCE

Given the high correlation coefficients between all demographics, CASS can be utilized for Andrews analysis to determine ideal anteroposterior maxillary position to streamline data collection and the planning process.

Visual facial perception of postsurgical cleft lip scarring assessed by laypeople via eye-tracking

OBJECTIVES:

This study aimed to evaluate the visual facial perception in response to scars associated with repaired cleft lip (CL) on a male adolescent model, as assessed by eye-tracking technology.

MATERIAL AND METHODS:

Unilateral and bilateral facial images of repaired CL on the upper lip and nasal asymmetry were added to an image of a male adolescent model, using Photoshop CS5 software. 40 laypeople eye movements were tracked by an infrared sensor of the Eye Tribe hardware in conjunction with OGAMA software. An analysis of variance was used to identify differences in total fixation time for the added areas of interest. A visual analog scale of attractiveness with a questionnaire were also incorporated into the study. Statistical analysis was performed using a significance level of P < 0.05.

RESULTS:

Significant differences were noted between the image with no scar and the image featuring a unilateral scar for total fixation time associated with the right eye (p = 0.002) and right nose area (p = 0.003), in addition to the numbers of fixations for the right eye (p = 0.005) and right nose area (p = 0.007). Comparing the image with no scar with the image featuring a bilateral scar showed a significant difference only for the number of fixations on the right eye (p = 0.005). The heatmaps and fixation point maps for both the unilateral and bilateral scar images indicated increased fixation for the scar areas. For the image with no scar, increased fixation was captured for the right eye area. Pearson's correlation coefficient test showed a moderate positive (p = 0.692) relationship when comparing to unilateral and bilateral cleft scars.

CONCLUSIONS:

The participating laypeople perceived the cleft-repaired faces and did not perceive any difference in attractiveness between the images featuring the unilateral and bilateral postsurgical clefts and lip scarring.