Comparing Casual Observer Perception of Facial Paralysis Subtypes

BACKGROUND: There is a spectrum of clinical presentations after facial nerve injury, from complete facial paralysis (CFP) to facial synkinesis (FS). OBJECTIVE: To measure and compare how laypersons perceive faces with CFP versus FS. METHODS: Lay observers were presented with standardized videos of 24 individuals' faces: 8 with CFP, 8 with FS, and 8 nonparalyzed Controls performing common facial expressions. Observers were given a questionnaire and asked to rate the faces on varying subjective measurements of facial perception. RESULTS: Five hundred and fifty-seven observers completed the survey. Observers viewed Control faces most favorably with higher perceived attractiveness and quality of life than CFP (p < 0.01; p < 0.01) and FS (p = 0.02; p < 0.01) faces. FS faces were rated more favorably than CFP faces (p < 0.01). CONCLUSIONS: There are measurable differences in how casual observers perceive faces with different subtypes of facial paralysis. Compared to nonparalyzed faces, both FS and CFP were viewed more negatively; however, CFP was perceived more negatively compared to FS. LEVEL OF EVIDENCE: N/A.