Factors Influencing the Early Visual Processing of Cleft Faces

Background:

Attractive people elicit more positive first impressions¹.  Conversely, facial deformity diminishes quality of life even after surgical reconstruction of a cleft deformity^2,3.  Symmetry has been shown to be one significant factor influencing aesthetic judgments of the face^4,5.  

Purpose:

To investigate the impact of cleft laterality and attractiveness on the early visual processing of faces with cleft lip. Primary aim: to study the visual markers leading to differential perception of patients with cleft lip.  Secondary aim: to evaluate the influence of observer personal history of facial deformity on visual processing of the cleft-affected face.  By delineating the focus of visual impression formation, surgeons and their patients may pinpoint the most salient facial features so as to better direct prioritization of surgical reconstruction.

Methods:

59 experimental and 59 control facial images were obtained from the senior author’s practice.

Experimental images included 15 individuals with repaired cleft lip (6R, 5B, 4L) and 45 with a variety of other facial diagnoses.  

240 subjects rated the images for attractiveness.

Twenty standardized lookzone regions were mapped onto each facial image.

A separate group of 170 subjects observed the images while an infrared eye-tracking camera continuously recorded their eye movements.

Personal history of observer facial deformity was solicited.

Factorial ANOVA analysis was performed to determine significance of gaze patterns and attractiveness between groups.

Outcomes Measured:

Image attractiveness was rated on a 1-7 Likert scale.

Total number of eye fixations within different lookzone regions was recorded.

Results. The following observations were statistically significant at p<0.01 level:

(i)            Subjects preferentially fixated on the periorbital regions of all faces, but paid greater attention to the perioral region of cleft-affected versus control faces. 

(ii)          Above phenomenon tracked closely to laterality of cleft. 

(iii)        Subjects fixated more on unilateral than on bilateral cleft lip.

(iv)          More attractive the overall cleft image rating, the less time the perioral region was fixated upon.

(v)            Observers with personal history of facial deformity fixated longer on the perioral region of cleft faces.

Conclusions:

Observers are drawn to the abnormal region of cleft faces.  Unilateral clefts - and cleft faces that are considered less attractive overall - induce relatively greater fixation within the perioral region.  Personal history of facial deformity may heighten detection of, and/or diversion towards, the cleft deformity.