Medstar Georgetown University Hospital, Washington, DC.
Virginia Commonwealth University Medical Center, Richmond.
JAMA Netw Open. 2020 Jun 1;3(6):e205495. doi: 10.1001/jamanetworkopen.2020.5495.
Facial paralysis has a significant effect on affect display, with the most notable deficit being patients' the inability to smile in the same way as those without paralysis. These impairments may result in undesirable judgements of personal qualities, thus leading to a significant social penalty in those who have the condition.
To quantify the association of facial paralysis with the way smiling patients are perceived by others with respect to personality traits, attractiveness, and femininity or masculinity and to evaluate the potential association of facial palsy-related patient-reported outcome measures with how patients are perceived by others.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cross-sectional study used 20 images of smiling patients with facial paralysis evaluated between January 1, 2014, and December 31, 2016. Using photograph editing software, the photographs were edited to create a simulated nonparalysis smiling facial appearance. A total of 40 photographs were split into 4 groups of 10 photographs, each with 5 altered and 5 unaltered photographs. The surveys were designed such that altered and unaltered photographs of the same patient were not placed in the same survey to avoid recall bias. Anonymous raters used a 7-point Likert scale to rate their perception of each patient's personality traits (ie, aggressiveness, likeability, and trustworthiness), attractiveness, and femininity or masculinity based on photographs in their assigned survey. Raters were blinded to study intent. Scores from the Facial Clinimetric Evaluation questionnaire were included to assess self-perception. Data were analyzed from November 11, 2019, to February 20, 2020.
Ratings of personality traits, attractiveness, and femininity or masculinity. Social function domain scores and overall scores were analyzed from the Facial Clinimetric Evaluation questionnaire.
This study included photographs of 20 patients with facial paralysis (mean [range] age, 54 [28-69] years; 15 [75%] women). A total of 122 respondents completed the survey (71 [61%] women). Most respondents were between the ages of 25 and 34 years (79 participants [65%]). Overall, smiling photos of patients with facial paralysis were perceived as significantly less likeable (difference, -0.29; 95% CI, -0.43 to -0.14), trustworthy (difference, -0.25; 95% CI, -0.39 to -0.11), attractive (difference, -0.47; 95% CI, -0.62 to -0.32), and feminine or masculine (difference, -0.21; 95% CI, -0.38 to -0.03) compared with their simulated preparalysis photographs. When analyzed by sex, smiling women with facial paralysis experienced lower ratings for likeability (difference, -0.34; 95% CI, -0.53 to -0.16), trustworthiness (difference, -0.24; 95% CI, -0.43 to -0.06), attractiveness (difference, -0.74; 95% CI, -0.94 to -0.55), and femininity (difference, -0.35; 95% CI, -0.58 to -0.13). However, smiling men with facial paralysis only received significantly lower ratings for likeability (difference, -0.24; 95% CI, -0.47 to -0.01) and trustworthiness (difference, -0.30; 95% CI, -0.53 to -0.07). As patients' self-reported social function and total Facial Clinimetric Evaluation scores increased, there was an increase in perceived trustworthiness (rs[480] = 0.11; P = .02) and attractiveness (rs[478] = 0.10; P = .04) scores by raters.
In this study, photographs of patients with facial paralysis received lower ratings for several personality and physical traits compared with digitally edited images with no facial paralysis. These findings suggest a social penalty associated with facial paralysis.
面瘫对面部表情的展示有显著影响，最明显的缺陷是患者无法像没有面瘫的人那样微笑。这些损伤可能导致他人对个人品质产生不良判断，从而对面瘫患者造成重大的社交惩罚。
量化面瘫对面瘫患者微笑时他人感知的个性特征、吸引力、女性气质或男性气质的关联，并评估面瘫相关患者报告结局测量与他人对患者感知的潜在关联。
设计、设置和参与者：这项回顾性的横断面研究使用了 20 张面瘫患者微笑的照片，这些照片拍摄于 2014 年 1 月 1 日至 2016 年 12 月 31 日。使用照片编辑软件，对照片进行编辑，以创建一个模拟的非瘫痪微笑的面部外观。共拍摄了 40 张照片，分为 4 组，每组 10 张照片，其中 5 张是修改过的，5 张是未修改过的。调查问卷的设计使得同一个患者的修改和未修改的照片不会放在同一个调查中，以避免回忆偏差。匿名评估者使用 7 点李克特量表根据其指定的调查，根据照片来评估每个患者的个性特征（即攻击性、可爱度和可信度）、吸引力和女性气质或男性气质。评估者对研究目的不知情。包括面部临床计量评估问卷的分数来评估自我感知。数据于 2019 年 11 月 11 日至 2020 年 2 月 20 日进行分析。
个性特征、吸引力和女性气质或男性气质的评价。从面部临床计量评估问卷中分析社会功能域评分和总分。
这项研究包括了 20 名面瘫患者的照片（平均[范围]年龄，54[28-69]岁；15[75%]名女性）。共有 122 名受访者完成了调查（71[61%]名女性）。大多数受访者年龄在 25 岁至 34 岁之间（79 名参与者[65%]）。总的来说，面瘫患者的微笑照片被认为明显不如他们模拟的非面瘫照片可爱（差异，-0.29；95%置信区间，-0.43 至-0.14）、值得信赖（差异，-0.25；95%置信区间，-0.39 至-0.11）、有吸引力（差异，-0.47；95%置信区间，-0.62 至-0.32）和女性化或男性化（差异，-0.21；95%置信区间，-0.38 至-0.03）。当按性别分析时，患有面瘫的微笑女性经历了较低的可爱度评分（差异，-0.34；95%置信区间，-0.53 至-0.16）、可信度评分（差异，-0.24；95%置信区间，-0.43 至-0.06）、吸引力评分（差异，-0.74；95%置信区间，-0.94 至-0.55）和女性化评分（差异，-0.35；95%置信区间，-0.58 至-0.13）。然而，患有面瘫的微笑男性仅收到较低的可爱度评分（差异，-0.24；95%置信区间，-0.47 至-0.01）和可信度评分（差异，-0.30；95%置信区间，-0.53 至-0.07）。随着患者自我报告的社会功能和总面部临床计量评估分数的增加，评估者对可信度（rs[480] = 0.11；P = .02）和吸引力（rs[478] = 0.10；P = .04）的评分也有所增加。
在这项研究中，与没有面瘫的人相比，面瘫患者的照片在几个个性和身体特征方面的评分较低。这些发现表明面瘫与社会惩罚有关。
