title: How facial lesions impact attractiveness and perception: differential effects of size and location.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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, χ(2) (1) = 0.03, P = 1.000; but large-central and large-peripheral differences and small-central and large-peripheral differences were significantly different, χ(2) (1) = 10.34, P = 0.004; and χ(2) (1) = 50.55, P < .001, respectively. DBRFS and attractiveness were poorly correlated (χ = -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, χ(2) (1) = 129.20, P < .001; and χ(2) (1) = 115.25, P < .001; but large-central to large-peripheral coefficients were not, χ(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.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland 21287, USA.
authors.forename: Andres
authors.initials: A
authors.lastname: Godoy
authors.forename: Masaru
authors.initials: M
authors.lastname: Ishii
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Byrne
authors.forename: Kofi D O
authors.initials: KD
authors.lastname: Boahene
authors.forename: Carlos O
authors.initials: CO
authors.lastname: Encarnacion
authors.forename: Lisa E
authors.initials: LE
authors.lastname: Ishii
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001504:Beauty; D001828:Body Image; D005145:Face / Q000503:physiopathology*; D005148:Facial Dermatoses / Q000503:physiopathology / Q000523:psychology; D005151:Facial Injuries / Q000503:physiopathology / Q000523:psychology / Q000601:surgery; D005153:Facial Neoplasms / Q000523:psychology / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012016:Reference Values; D012044:Regression Analysis; D012720:Severity of Illness Index; D012737:Sex Factors; D055815:Young Adult