title: The social penalty of facial lesions: new evidence supporting high-quality reconstruction.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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
  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.
  
  
  METHODS
  NA.
authors.affiliation: Division of Facial Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland2Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland.
authors.forename: Jacob K
authors.initials: JK
authors.lastname: Dey
authors.affiliation: Division of Facial Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland2Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland.
authors.forename: Lisa E
authors.initials: LE
authors.lastname: Ishii
authors.affiliation: Division of Facial Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland2Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Byrne
authors.affiliation: Division of Facial Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland2Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland.
authors.forename: Kofi D O
authors.initials: KD
authors.lastname: Boahene
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland3Division of Rhinology, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland.
authors.forename: Masaru
authors.initials: M
authors.lastname: Ishii
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001828:Body Image; D005145:Face / Q000002:abnormalities* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000379:methods*; D012938:Social Perception