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Original Investigation
January 10, 2019

Assessment of the Influence of “Other-Race Effect” on Visual Attention and Perception of Attractiveness Before and After Rhinoplasty

Author Affiliations
  • 1Johns Hopkins University School of Medicine, Baltimore, Maryland
  • 2Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
  • 3Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
  • 4Associate Editor, JAMA Facial Plastic Surgery
  • 5Facial Plastic Surgery, Department of Otolaryngology, Centro Médico Imbanaco, Cali, Colombia
  • 6Facial Plastic Surgicenter, Baltimore, Maryland
  • 7Division of Rhinology and Sinus, Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
JAMA Facial Plast Surg. Published online January 10, 2019. doi:10.1001/jamafacial.2018.1697
Key Points

Question  Does the race of a casual observer and/or patient influence perception of rhinoplasty?

Findings  This survey study consisted of 134 observers who participated in eye tracking while viewing images of white and Latin American patients who underwent rhinoplasty, and a separate 134 participants who graded the attractiveness of the patients prerhinoplasty and postrhinoplasty. White participants demonstrated increased same-race visual fixation and reported postoperative attractiveness increases across race, whereas Latin American participants did not exhibit racially associated gaze allocation and only reported significant postoperative attractiveness increase in their own racial group.

Meaning  The race of both patients and observers appears to influence visual attention and perceived attractiveness after rhinoplasty.

Abstract

Importance  The “other-race effect” describes the phenomenon in which individuals demonstrate greatest recognition ability among faces of their own race. Thus, in our multicultural world, it follows that race influences social interactions. However, the association of race with perception of plastic surgery outcomes has not been studied.

Objective  To objectively measure how the other-race effect influences perception of white and Latin American patients undergoing rhinoplasty by using eye-tracking technology and survey methodology.

Design, Setting, and Participants  In the first part of the study, 134 participants viewed 32 paired facial images of white and Latin American patients, either prerhinoplasty or postrhinoplasty, on an eye-tracking system that recorded observer scan paths. In the second part of this study, the same patient images were individually graded by a separate group of 134 participants for degree of racial identification and perceived attractiveness.

Main Outcomes and Measures  The primary outcome was to measure the influence of patient and observer race on perception of rhinoplasty outcomes. For the eye-tracking part, planned hypothesis testing was conducted using an analysis of variance to compare patient race, rhinoplasty status, and attractiveness with respect to visual fixation time.

Results  Of the 134 eye-tracking participants, 68 (51%) were women and the mean (SD) age was 26.4 (7.7) years; of the 134 graders, 64 (48%) were women and the mean (SD) age was 25.0 (6.9) years. Rhinoplasty did not affect racial identity scores among either same-race or other-race evaluators. Visual fixation times for white faces were significantly increased compared with Latin American faces among all casual observer groups (white observers mean change, −20.14 milliseconds; 95% CI, −29.65 to −10.62 milliseconds; P<.001; Asian observers mean change, −39.04 milliseconds; 95% CI, −48.95 to −29.15 milliseconds; P<.001; and African American observers mean change, −20.73 milliseconds; 95% CI, −37.78 to −3.69 milliseconds; P<.02), with the exception of Latin American observers (mean change, −7.8 milliseconds; 95% CI, −29.15 to 14.39 milliseconds; P<.51). With respect to attractiveness, white graders reported a significant postrhinoplasty increase across both races (white patients mean change, 8.07 points; 95% CI, 5.01-11.12 points; P<.001; and Latin American patients mean change, 3.69 points; 95% CI, 0.87-6.49 points; P=.01), whereas Latin American graders only observed a significant attractiveness increase in their own race (Latin American patients mean change, 10.50 points; 95% CI, 1.70-19.32 points; P = .02). Neither perceived attractiveness nor rhinoplasty status influenced fixation times.

Conclusions and Relevance  Both patient and observer race influence visual attention and perception of attractiveness before and after rhinoplasty. These findings underscore the importance of counseling patients that the influence of rhinoplasty, as perceived by the casual observer, may vary by race or ethnicity of the observer group.

Level of Evidence  NA.

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