The social penalty of facial lesions: New evidence supporting high-quality reconstruction

IMPORTANCE: To date, there have been no studies attempting to measure the multidimensional impact of facial lesions, before and after reconstruction, on social conversation. OBJECTIVE: To measure the direct social impact of facial lesions before and after surgical reconstruction. DESIGN, SETTING, AND PARTICIPANTS: Prospective randomized controlled experiment at an academic tertiary referral center. One hundred twenty casual observers viewed images of faces with lesions of varying sizes and locations before and after reconstruction as well as faces without lesions (normal faces) for comparison. MAIN OUTCOMES AND MEASURES: Observers rated faces using a battery of metrics, including how comfortable they would be having a conversation with the participant in each facial image. The conversation questions were answered on a scale from 0 to 100, where the higher the score, the more comfortable the observer would be conversing with the subject. RESULTS: The mean (SD) conversation score for participants with normal faces was 85.02 (17.95) of 100 points. Facial lesions had a negative effect (or, a penalty) on conversation (61.63 [29.50]). Structural equation modeling showed this conversation penalty varied with lesion size and location, with large and central lesions generating the greatest penalty. Reconstructive surgery increased observers' comfort and willingness to converse with individuals with facial lesion by an average of 19.83 (95% CI, 17.49-22.17), an improvement that also varied with preoperative lesion size and location. Planned hypothesis testing showed that reconstructive surgery normalized observer comfort in communicating with people with small peripheral, small central, and large peripheral lesions. However, substantial discomfort communicating with patients with large central lesions remained after surgery. Observer-rated facial attractiveness, affect, and perceived quality of life also influenced this social communication measure. CONCLUSIONS AND RELEVANCE: Facial lesions induce a significant social penalty as rated by the casual observer. Specifically, observers are less comfortable communicating with people who have facial lesions. Surgical reconstruction of facial lesions increased observers' comfort in conversing with people with facial lesions, an impact that varied with lesion size and location. LEVEL OF EVIDENCE: NA.