How Facial Lesions Impact Attractiveness and Perception: Differential Effects of Size and Location

Objectives/Hypothesis: To determine the effect of facial lesion size and location on perceptions of attractiveness and importance for repair. We hypothesized that attractiveness scores and importance for repair would be dependent on lesion size and location. Study Design: Randomized controlled experiment. Methods: Forty-five subjects viewed 35 photographs of normal faces and faces with lesions of different sizes and locations. They rated attractiveness, how disfiguring, how bothered, and how important they considered repair. Results: Iterated factor analysis showed "bothered, disfigured, and important to repair" addressed the same domain, so a disfigured/bothersome/repair factor score (DBRFS) was used. A mixed-effects regression model for attractiveness showed small-central and small-peripheral coefficients were not significantly different, chi(2)(1) = 0.03, P = 1.000; but large-central and large-peripheral differences and small-central and large-peripheral differences were significantly different, chi(2)(1) = 10.34, P = 0.004; and chi(2)(1) = 50.55, P < .001, respectively. DBRFS and attractiveness were poorly correlated (chi = -0.29). A mixed-effects regression for DBRFS showed small-central to large-central and the small-central to large-peripheral coefficients were significantly different, chi(2)(1) = 129.20, P < .001; and chi(2)(1) = 115.25, P < .001; but large-central to large-peripheral coefficients were not, chi(2)(1) = 0.14, P = 1.000. Conclusions: The attractiveness penalty caused by a lesion was correlated with size but not location. Importance to repair was correlated with how disturbing and bothersome it was but not with how the lesion diminished attractiveness. All large lesions and small central lesions were considered important to repair by observers. These results will help us predict the true impact of lesions and support evidence-based treatment plans.