title: Appearance is a function of the face.
abstract: BACKGROUND
  Increasingly, third-party insurers deny coverage to patients with posttraumatic and congenital facial deformities because these are not seen as "functional." Recent facial transplants have demonstrated that severely deformed patients are willing to undergo potentially life-threatening surgery in search of a normal physiognomy. Scant quantitative research exists that objectively documents appearance as a primary "function" of the face. This study was designed to establish a population-based definition of the functions of the human face, rank importance of the face among various anatomical areas, and determine the risk value the average person places on a normal appearance.
  
  
  METHODS
  Voluntary adult subjects (n = 210) in three states aged 18 to 75 years were recruited using a quota sampling technique. Subjects completed study questionnaires of demography and bias using the Gamble Chance of Death Questionnaire and the Rosenberg Self-Esteem Scale.
  
  
  RESULTS
  The face ranked as the most important anatomical area for functional reconstruction. Appearance was the fifth most important function of the face, after breathing, sight, speech, and eating. Normal facial appearance was rated as very important for one to be a functioning member of American society (p = 0.01) by 49 percent. One in seven subjects (13 percent) would accept a 30 to 45 percent risk of death to obtain a "normal" face.
  
  
  CONCLUSIONS
  Normal appearance is a primary function of the face, based on a large, culturally diverse population sample across the lifespan. Normal appearance ranks above smell and expression as a function. Restoration of facial appearance is ranked the most important anatomical area for repair. Normal facial appearance is very important for one to be a functional member of American society.
authors.affiliation: Division of Plastic Surgery, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, 1 Robert Wood Johnson Place, MEB 506, New Brunswick, NJ 08901, USA. borahgr@umdnj.edu
authors.forename: Gregory L
authors.initials: GL
authors.lastname: Borah
authors.forename: Marlene K
authors.initials: MK
authors.lastname: Rankin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004954:Esthetics / Q000523:psychology; D005145:Face / Q000502:physiology*; D005149:Facial Expression; D006801:Humans; D008875:Middle Aged; D012903:Smell; D012938:Social Perception; D055815:Young Adult