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Visual Fixation Patterns Of Various Forms Of Facial Difference.
Thanapoom Boonipat, BS1, Tiffany Brazile, BA1, Oliver Darwish2, Philip Montana, BA1, Kevin Fleming, PhD3, Mitchell Stotland, MD4.
1Geisel School of Medicine at Dartmouth, Hanover, NH, USA, 2Dartmouth College, Hanover, NH, USA, 3Norwich University, Norwich, VT, USA, 4Sidra Medical Center, Doha, Qatar.

Facial difference significantly affects quality of life, and ample evidence suggests that social bias and stigmatization often persist even after the provision of high-quality facial reconstructive intervention. In order to investigate observers’ early visual processing of a variety of forms of facial difference, we employed eye-tracking technology1.
To explore observer eye-tracking patterns for a variety of forms of facial difference2,3. It is expected that this information will better inform surgeons’ conversations with patients by improving their understanding of how faces are reflexively interpreted by others, and possibly help focus surgical reconstructive priorities. Moreover, this information may facilitate the evolving development of machine-vision by contributing new information regarding the perceptual response to the human face4,5.
118 experimental and 79 control facial images were obtained from the senior author’s practice.
Experimental images included: 29 cleft lip, 22 facial aging, 18 facial lesion, 16 ear deformity, 14 HIV lipodystrophy, 11 nasal deformity, 6 dermatochalasis. All images were paired with age-matched controls.
Twenty lookzone regions were mapped onto each facial image.
A separate group of 265 subjects observed a randomly chosen subset of 40 images while an infrared eye-tracking camera continuously recorded their eye movements.
Factorial ANOVA analysis was performed to determine significance of differences between groups.
Outcomes Measured:
The total number of eye fixations within different lookzone regions was recorded. Factorial ANOVA analysis was performed to determine significance of gaze patterns between groups.
Results. The following observations were statistically significant at p<0.05 level.
observers’ gaze is drawn preferentially to the periorbital region when looking at both control and all forms of facial difference considered
Compared to when looking at control images, observers’ gaze is drawn preferentially to:
the upper lid region for images with dermatochalasis
the lower lid region for images with facial aging
the nasal tip and sidewall regions for images with nasal deformity
the perioral regions for images with cleft lip
the auricular regions for images with ear deformity
Using a large sample size of both facial images and observers, our original findings demonstrate that eyetracking technology can be used to clearly discriminate between a variety of forms of facial difference. Implications towards development of machine vision will be discussed.
Schijndel OV et al. Eye tracker based study: Perception of faces with a cleft lip and nose deformity. J Craniomaxillofac Surg 2015; 43:1620-1625
Dey JK, et al. Seeing Is Believing: Objectively Evaluating the Impact of Facial Reanimation Surgery on Social Perception Laryngoscope; 2014 124(11):2489-2497
Godoy A, et al The Straight Truth: Measuring Observer Attention to the Crooked Nose. Laryngoscope; 2011 121(5):937-941.
Ferry Q, et al. Diagnostically relevant facial gestalt information from ordinary photos. eLife; 2014;3:e02020
Ideta Shinji, et al Evaluation of Surgical Outcomes for Ptosis Surgery by Face Recognition Software. January/February. Asia Pac J Ophthalmol; 2015 4(1):14-18

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