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Investigation of Valence-Specific Laterality Effect on Approach–Avoidance Responses to Facial Expressions

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Abstract Recent research has identified 2 initial processes involved in interpreting emotions from facial expressions: the elicitation of an approach–avoidance response and the judgment of valence (positive or negative). However, it remained unclear whether these processes are independent or related. This study investigated their relationship by using the valence-specific laterality effect. The experiment involved 42 Japanese university students who were tasked with using a joystick to respond to facial expressions randomly displayed on the left and right sides of the screen. Predictions suggested that if the processes were related, a stronger avoidance response would occur for an angry expression presented on the left side. Results revealed no impact of facial expression position on the avoidance response. This finding suggests the independence of the 2 processes, indicating that the initial approach–avoidance response and valence judgment operate separately in interpreting emotions from facial expressions. It was proposed that future research should more thoroughly investigate the distinct processes governing approach–avoidance reactions and valence judgments.

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  • Research Article
  • Cite Count Icon 1
  • 10.1111/jpr.12487
Approach–Avoidance Responses to Affective Facial Expressions and Bodily Posture1,2
  • Nov 19, 2023
  • Japanese Psychological Research
  • Shinnosuke Ikeda

Human beings perceive the emotions of others through various cues, such as facial expressions, voice, and bodily posture. These social signals have been acquired evolutionarily, and reports suggest that emotions are recognized to some extent in a culturally universal pattern. It has also been suggested that an observer's approach or avoidance responses toward the expressor occur at the initial stage of emotion perception. However, such approach–avoidance reactions have hitherto been examined mainly in response to facial expressions and not bodily postures. Therefore, this study examined approach–avoidance responses to anger and fear as visualized through facial expressions and bodily postures. The study sample comprised 58 university students. The results showed that, as in a previous study, approach responses to fear and avoidance responses to anger were dominant in both facial expression and bodily posture conditions. This suggests that bodily posture and facial expression are social signals that can elicit an approach–avoidance response from the observer.

  • Research Article
  • Cite Count Icon 5
  • 10.1002/ijop.12803
Approach‐avoidance responses and categorical perception of ambiguous facial expressions
  • Aug 18, 2021
  • International Journal of Psychology
  • Shinnosuke Ikeda

Emotion perception of facial expressions involves two processes: quick approach-avoidance responses and subsequent sorting into emotional categories (i.e., happiness, anger), considering the context. Sorting of morphed ambiguous facial expressions is known to occur categorically, but the occurrence of approach-avoidance responses for morphed facial expressions is yet to be investigated. The present study used morphed angry and fearful facial expressions and measured approach-avoidance responses among Japanese university students (Experiment 1, n= 29). Similar experiments with linguistic load (Experiment 2, n= 28) and visual load (Experiment 3, n= 29) were conducted. The results indicated categorical perception in the sorting of facial expressions but no approach-avoidance response for morphed expressions. Furthermore, linguistic load affected the categorisation of facial expressions, but neither linguistic load nor visual load affected the approach-avoidance response. These results support the idea that the non-linguistic approach-avoidance response and the linguistic categorisation of facial expressions are two different processes. The nature of the emotional perception process is also discussed.

  • Research Article
  • Cite Count Icon 1
  • 10.1080/20590776.2022.2040335
Toddlers‘ categorization of emotional facial expressions by emotion category and approach-avoidance orientation
  • Feb 23, 2022
  • Educational and Developmental Psychologist
  • Shinnosuke Ikeda

Objective It has been observed that toddlers tend to miscategorize several negative emotions (e.g., sadness, anger). On the other hand, when we infer others’ emotions, an approach-avoidance tendency toward facial expressions is perceived antecedently before linguistically categorizing them into emotion-word-based categories, such as sadness, anger, and fear. Therefore, children may have categorized facial expressions in an approach-avoidance framework before they were able to classify them in emotion-word-based categories. Method The present study explored this possibility by asking 3-year-old Japanese children (N = 36) to categorize facial expressions using both an emotion label and action response (i.e., approach-avoidance) in the same procedure. Results Results revealed that while toddlers were confused by negative facial expressions using emotion labels, they could distinguish them using action responses like adults. Furthermore, children’s categorization of facial expression by emotion label was partially similar to categorization by approach-avoidance framework. Conclusions These findings suggest that although toddlers have difficulties in distinguishing between several negative facial expressions by emotion-word-category, they can distinguish how to react to these facial expressions just like an adult. Furthermore, toddlers might construct emotion-word-based categories based on approach-avoidance in early childhood. Finally, the developmental trajectories of categorization of facial expression by emotion-word-based category and approach-avoidance response are discussed. KEY POINTS What is already known about this topic: The skill of reading emotions from facial expressions develops in early childhood. In early childhood, some negative facial expressions are confused with each other. Early young children might recognize facial expressions based on the axis of approaching or avoiding. What this topic adds: This study examines how to classify facial expressions in 3-year-old children. While 3-year-olds confused negative emotions such as anger and fear, they differentiated between facial expressions on the axis of approaching or avoiding the facial expression. Categorizations based on emotional categories and approach-avoidance are similar, suggesting that children may categorize facial expressions based on the approach-avoidance axis in early childhood.

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  • Research Article
  • Cite Count Icon 12
  • 10.3390/ijerph18020822
Determinants of Residents’ Approach–Avoidance Responses to the Personal Carbon Trading Scheme: An Empirical Analysis of Urban Residents in Eastern China
  • Jan 1, 2021
  • International Journal of Environmental Research and Public Health
  • Daoyan Guo + 3 more

The personal carbon trading (PCT) scheme is a policy instrument for reducing downstream carbon emissions and creating a green lifestyle, and a bottleneck hampering its implementation is the behavioral willingness of residents. Due to a pre-existing stimulus-response association, the willingness of residents can be intuitively reflected by their approach–avoidance responses. This study theoretically analyzed the mechanisms for influencing residents’ approach–avoidance responses towards the personal carbon trading scheme based on open-ended interviews, and empirically examined the mechanisms by developing rating scales and conducting questionnaire surveys on urban residents in eastern China. Findings showed that residents’ approach–avoidance responses could be negatively affected by their preference for comfort, whereas they were positively impacted by their ecological values, sense of social responsibility, cognition of the behaviors for carbon emission reduction, and cognition of personal carbon trading. In terms of subjective norms, the culture of environmentalism had a positive effect on residents’ responses to PCT scheme, while the culture of consumerism caused a negative impact on their responses. Furthermore, the perceived behavioral controls of residents partially mediated the relationships between their psychological characteristics and approach–avoidance responses. Finally, primary and pivotal suggestions were proposed for nudging Chinese urban residents towards approaching the personal carbon trading scheme, which provide theoretical support and practical guidance for its implementation.

  • Research Article
  • Cite Count Icon 4
  • 10.1002/ijop.12886
Approach-avoidance behavioural patterns towards an affective voice.
  • Dec 30, 2022
  • International Journal of Psychology
  • Shinnosuke Ikeda

Facial expressions are evolutionarily acquired social signals that are processed rapidly by the receiver when deciding to either approach or avoid the person sending the signal. The predominance of the approach or avoidance responses has been examined for various facial expressions. Similar to facial expressions, the approach-avoidance response to affective voice may have been acquired evolutionarily. However, studies examining approach-avoidance to an affective voice are limited. This study used the approach-avoidance task framework developed for facial expressions to determine the dominant behavioural responses to affective voices that indicate either happiness or anger. The results show that the approach response was dominant for the happy voice, while the avoidance response was dominant for the angry voice. This tendency was observed even without the presence of any facial stimuli. These results suggest that an affective voice may be an evolutionarily acquired approach-avoidance-inducing social signal, similar to facial expressions.

  • Research Article
  • Cite Count Icon 11
  • 10.1002/cav.1539
Asymmetric facial expressions: revealing richer emotions for embodied conversational agents
  • Jul 19, 2013
  • Computer Animation and Virtual Worlds
  • Junghyun Ahn + 3 more

ABSTRACTIn this paper, we propose a method to achieve effective facial emotional expressivity for embodied conversational agents by considering two types of asymmetry when exploiting the valence–arousal–dominance representation of emotions. Indeed, the asymmetry of facial expressions helps to convey complex emotional feelings such as conflicting and/or hidden emotions due to social conventions. To achieve such a higher degree of facial expression in a generic way, we propose a new model for mapping the valence–arousal–dominance emotion model onto a set of 12 scalar facial part actions built mostly by combining pairs of antagonist action units from the Facial Action Coding System. The proposed linear model can automatically drive a large number of autonomous virtual humans or support the interactive design of complex facial expressions over time. By design, our approach produces symmetric facial expressions, as expected for most of the emotional spectrum. However, more complex ambivalent feelings can be produced when differing emotions are applied on the left and right sides of the face. We conducted an experiment on static images produced by our approach to compare the expressive power of symmetric and asymmetric facial expressions for a set of eight basic and complex emotions. Results confirm both the pertinence of our general mapping for expressing basic emotions and the significant improvement brought by asymmetry for expressing ambivalent feelings. Copyright © 2013 John Wiley & Sons, Ltd.

  • Research Article
  • Cite Count Icon 22
  • 10.1111/j.1479-8301.2007.00179.x
Age determines memory for face identity and expression
  • Jun 1, 2007
  • Psychogeriatrics
  • Egemen Savaskan + 5 more

Background: The recognition of facial expressions is an important component of emotion processing which contributes to interactional behavior. One of the factors highly associated with potential decline of ability in behavioral tasks is age.Methods: We have investigated age‐related changes in facial identity and expression memory of healthy subjects in three age groups: young adults (20–40 years), elderly adults (60–80 years) and, for the first time in the literature, very old adults (over 80 years of age). Using a picture test, photographs of faces with happy or angry expressions were presented to study participants during the encoding task, and the memory for identity and emotional facial expression was investigated in a subsequent recognition task showing emotionally neutral faces. Half of the faces presented in the recognition task were initially shown in the encoding task.Results: Age interacted with the memory process: the ability to recognize both facial identity and emotional expression declined with advanced age. Happy facial expressions were better recognized in all age groups. Although there was a continuous overall decrease in recognition of both happy and angry expressions with advanced age, the effect favoring happy facial expressions was stable also in very old adults. Other factors such as gender or educational level did not affect the memory process for facial expressions.Conclusions: Our findings suggest that age is a significant determinant of memory for facial identity and emotional expression, and that, similar to younger adults, the recognition process of the elderly favors happy emotional facial expressions.

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  • Research Article
  • Cite Count Icon 13
  • 10.1371/journal.pone.0263990
Interpersonal responses to facial expressions of disgust, anger, and happiness in individuals with varying levels of social anxiety.
  • Apr 7, 2022
  • PLOS ONE
  • Marije Aan Het Rot + 3 more

Facial expression recognition has been studied extensively, including in relation to social anxiety. Nonetheless, a limited number of studies examined recognition of disgust expressions. Results suggest that disgust is perceived as more threatening than anger, and thus may invite more extreme responses. However, few studies have examined responses to facial expressions. These studies have focused on approach-avoidance responses. Our primary aim was to examine to what extent anger and disgust expressions might invite interpersonal responses in terms of quarrelsomeness-agreeableness and dominance-submissiveness. As social anxiety has been previously associated with a heightened sensitivity to anger and disgust expressions, as well as with alterations in quarrelsomeness-agreeableness and dominance-submissiveness, our secondary aim was to examine whether social anxiety would moderate these responses. Participants were 55 women and 43 men who completed social anxiety measures, including the Brief Fear of Negative Evaluation scale, and two tasks that involved "targets" expressing anger, disgust, or happiness at 0%, 50%, or 100%. Participants first indicated how quarrelsome or agreeable and how dominant or submissive they would be towards each target, and then how much they would avoid or approach each target. While 100% disgust and anger expressions invited similar levels of quarrelsomeness and avoidance, 50% disgust invited more quarrelsomeness and stronger avoidance than 50% anger. While these patterns were not meaningfully moderated by social anxiety, individuals with higher BFNE scores showed a relatively strong approach of happy faces. Actual interpersonal behaviour in response to facial expressions was not assessed. Findings support the relevance of disgust as an interpersonal signal and suggest that, especially at mild intensity, disgust may have a stronger impact than anger on people's quarrelsomeness and avoidance responses. Findings provided no support for the view that people with social anxiety would be particularly responsive to disgust (or anger) expressions.

  • Research Article
  • Cite Count Icon 1
  • 10.1371/journal.pone.0263990.r003
Interpersonal responses to facial expressions of disgust, anger, and happiness in individuals with varying levels of social anxiety
  • Apr 7, 2022
  • PLOS ONE
  • Marije Aan Het Rot + 4 more

Background and objectivesFacial expression recognition has been studied extensively, including in relation to social anxiety. Nonetheless, a limited number of studies examined recognition of disgust expressions. Results suggest that disgust is perceived as more threatening than anger, and thus may invite more extreme responses. However, few studies have examined responses to facial expressions. These studies have focused on approach-avoidance responses. Our primary aim was to examine to what extent anger and disgust expressions might invite interpersonal responses in terms of quarrelsomeness-agreeableness and dominance-submissiveness. As social anxiety has been previously associated with a heightened sensitivity to anger and disgust expressions, as well as with alterations in quarrelsomeness-agreeableness and dominance-submissiveness, our secondary aim was to examine whether social anxiety would moderate these responses.MethodsParticipants were 55 women and 43 men who completed social anxiety measures, including the Brief Fear of Negative Evaluation scale, and two tasks that involved “targets” expressing anger, disgust, or happiness at 0%, 50%, or 100%. Participants first indicated how quarrelsome or agreeable and how dominant or submissive they would be towards each target, and then how much they would avoid or approach each target.ResultsWhile 100% disgust and anger expressions invited similar levels of quarrelsomeness and avoidance, 50% disgust invited more quarrelsomeness and stronger avoidance than 50% anger. While these patterns were not meaningfully moderated by social anxiety, individuals with higher BFNE scores showed a relatively strong approach of happy faces.LimitationsActual interpersonal behaviour in response to facial expressions was not assessed.ConclusionsFindings support the relevance of disgust as an interpersonal signal and suggest that, especially at mild intensity, disgust may have a stronger impact than anger on people’s quarrelsomeness and avoidance responses. Findings provided no support for the view that people with social anxiety would be particularly responsive to disgust (or anger) expressions.

  • Research Article
  • Cite Count Icon 54
  • 10.1037/a0032259
Not all behaviors are controlled in the same way: Different mechanisms underlie manual and facial approach and avoidance responses.
  • Jan 1, 2014
  • Journal of Experimental Psychology: General
  • Roland Neumann + 2 more

How does affect impact approach and avoidance responses? Whereas approaches in a Darwinian tradition have emphasized a direct affect-behavior link, recent approaches in cognitive psychology have argued that the relation of affect to approach and avoidance responses depends on the coding of the behavioral response. We suggest that the relation of affect to approach and avoidance responses depends on the kind of behavior itself. Specifically, we tested the assumption that facial approach and avoidance responses are permanently linked to affect, whereas such links are more flexible and dependent on the coding of actions with manual responses. In one experiment, the response labels sun and rain were assigned to manual approach and avoidance responses and facial contractions of the zygomaticus and the corrugator muscles. Manual responses were facilitated when stimulus valence matched the valence of the response labels, whereas facial responses were facilitated when stimulus valence matched the affect expressed by these responses. The results suggest that the links between affect and manual responses depend on how these responses are cognitively coded, whereas the links between affect and facial responses are much less affected by such coding.

  • Research Article
  • 10.1111/jpr.12555
Editorial: Studies of Face and Body
  • Oct 1, 2024
  • Japanese Psychological Research
  • Jiale Yang + 1 more

This special issue of Japanese Psychological Research, titled Studies of Face and Body, explores the intricate mechanisms and multifaceted aspects of face and body perception, cognition, and social significance. This issue is part of a project funded by the MEXT Grant-in-Aid for Scientific Research on Innovative Areas, titled Construction of Face−Body Studies in Transcultural Conditions. This research project initiative on face and body studies in Japan spanned from 2017 to 2022 and aims to heighten awareness about the unconscious expressions of faces and bodies and the cultural differences in these expressions. Facial and bodily expressions serve as transparent mediums, revealing individual histories and enabling people to be understood by others. However, research has often been conducted on faces and bodies as separate entities. Recognizing the importance of integrating these two fields, our project aims to uncover the differences in facial and bodily expressions across diverse cultures and to explore the possibilities for developing cultural understanding through faces and bodies. By bringing unconscious facial and bodily expressions to conscious awareness, this field of study seeks to enhance the understanding of different cultures and the acceptance of diverse individuals. Multidisciplinary research methods, including psychological, anthropological, and philosophical perspectives, are used to elucidate cultural differences, aiming to clarify the commonalities and differences in facial and body expressions, considering both cultural and individual variations. Our project's goals align with the recent trend of developing integrated research on face and body perception, as evidenced by major international psychological conferences, such as the Vision Sciences Society (VSS), which included presentations on face and body perception in the same session in VSS 2024. As a part of our project and to promote research on face and body studies, we feature this special issue. This special issue received 22 submissions, of which 12 were accepted for publication: eight focusing on face studies and four on body studies. We are grateful for the substantial number of submissions, which showcase a diverse range of topics. Among the accepted papers, there are four notable review papers. Fort et al. (2024) explore the developmental trajectory of face processing and provide a comprehensive view of perceptual narrowing. Silvestri and Macchi Cassia (2024) examine how infants perceive trustworthiness in faces and the role of spatial frequency in this process. Tanaka (2024) offers a thorough overview of how body image develops in infants. Amita et al. (2024) review the neuronal mechanisms involved in face processing in primates. In addition to these reviews, experimental studies provide fresh insights into various aspects of face and body perception. Chuang and Fujiwara (2024) address the unexplored cross-cultural variability of facial mimicry by analyzing video data from Japan, Spain, and Taiwan. The study finds significant differences in mimicry extent among the different cultures and examines the association between personality traits and mimicry. Yagi et al. (2024) measure observers' tendencies to approach infant faces using a manikin task, where participants are asked to either move closer to or farther away from displayed face images. The participants showed a stronger inclination to approach infant faces compared to adult faces, suggesting that infant faces are more effective in eliciting approach behaviors. Fukuichi et al. (2024) identify helpful body-scan postures for people with ADHD tendencies, finding that supine postures made the body scan meditation easier to perform for individuals with hyperactivity/impulsivity tendencies. Yang et al. (2024) examine factors that distinguish real human motion from AI-generated movements, highlighting criteria such as kinematics, context, body mechanics, and principles of physical laws. Ikeda (2024) explores approach-avoidance responses to anger and fear as visualized through facial expressions and bodily postures, suggesting that both signals can elicit these responses. Nittono and Ohashi (2024) investigate whether the task of evaluating cuteness-versus-beauty affects smiling responses. The study shows that observing cuteness enhances smiling responses more than observing beauty. Shimizu et al. (2024) investigate the relationship between the intensity of emotional expressions in facial stimuli and the receivers' decoding accuracy for six basic emotions. The study found that higher intensity does not necessarily lead to higher decoding accuracy. Namba et al. (2024) examine how facial expressions of fun convey information and how this varies depending on social context. The results indicate that expressions of internal states are primary but vary in strength based on the presence of others. This special issue serves as a comprehensive resource for researchers, offering a deeper understanding of the multifaceted nature of face and body processing. By bringing together diverse perspectives and cutting-edge research, we aim to foster further advancements in this vibrant field of psychological science. We hope that the articles presented in this issue will inspire young researchers, especially those new to the field of face and body studies, to delve more deeply into this fascinating area of research and contribute to its future development.

  • Research Article
  • Cite Count Icon 6
  • 10.1080/24750573.2017.1367566
Assessment of relationship between comorbid oppositional defiant disorder and recognition of emotional facial expressions in children with attention-deficit/hyperactivity disorder
  • Sep 8, 2017
  • Psychiatry and Clinical Psychopharmacology
  • Halil Kara + 4 more

Objectives: Attention-deficit/hyperactivity disorder (ADHD) is the most frequent neurobehavioural disorder in childhood. ADHD is associated with impaired academic performance, cognitive, and emotional deficits. Moreover, comorbid oppositional defiant disorder (ODD) is leading to more severe impairment in social performance. Social cognition involves recognition, encoding, and interpretation of emotions from faces. Basic facial expressions that include sadness, happiness, anger, disgust, fear, and surprise are the easiest emotions to recognize. We aimed to demonstrate facial expression recognition impairments that might occur more frequently in children with co-occurring ADHD/ODD than patients with ADHD only. Thus, children with the co-occurrence of ODD may suffer more severely from social and behavioural difficulties.Methods: Forty patients diagnosed with ADHD and/or co-occurring ADHD/ODD according to DSM-IV-TR criteria were compared with a parallel (by gender, age, and educational state) 11 healthy children as a control group in this study. Clear facial images of each emotion were used as well as two additional sets of photos include 50% blurred images and cropped eye images were added as distractors then all images represented with black and white tone for emotion recognition task via facial expression. Angry expressions presented as target expressions. DSM-IV-Based Screening and Rating Scale for Children and Adolescents with attention deficit and disruptive behaviour disorders, the Conners’ Teachers Rating Scale/Revised Long Form and the Conners’ Parent Rating Scale/Revised Long Form were used to provide diagnostic objectivity.Results: Control group statistically performed better than ADHD group on recognition of emotional facial expressions. Results showed no statistically significant differences between the ADHD and ADHD/ODD group on recognition of emotional facial expressions. However, according to results of emotion recognition task via facial expressions, there were statistically significant differences between pure ADHD and comorbid ADHD+ODD groups in happy and neutral expressions. ADHD/ODD group tend to attribute more meaning to neutral facial expressions. Additionally there was statistically significant difference between control group and ADHD group according to recognition of angry expressions. There were statistically significant differences between the groups according to recognition of sad expressions in all clear, blurred, and eye photographs.Conclusions: Difficulties in recognizing emotional facial expressions were observed in children with ADHD. A statistically significant association was established between presence of ADHD and impaired recognition of facial emotion expressions independent from the scores of the disruptive behaviour rating scale. Comorbid ODD was not associated with recognition of emotional facial expressions including angry expressions. Recognition of angry expressions was not found as a predictor for disruptive behaviour disorders.

  • Research Article
  • Cite Count Icon 64
  • 10.1037/emo0000835
The Role of Movement Kinematics in Facial Emotion Expression Production and Recognition
  • Mar 4, 2021
  • Emotion (Washington, D.C.)
  • Sophie Sowden + 4 more

The kinematics of peoples’ body movements provide useful cues about emotional states: for example, angry movements are typically fast and sad movements slow. Unlike the body movement literature, studies of facial expressions have focused on spatial, rather than kinematic, cues. This series of experiments demonstrates that speed comprises an important facial emotion expression cue. In Experiments 1a–1c we developed (N = 47) and validated (N = 27) an emotion-induction procedure, and recorded (N = 42) posed and spontaneous facial expressions of happy, angry, and sad emotional states. Our novel analysis pipeline quantified the speed of changes in distance between key facial landmarks. We observed that happy expressions were fastest, sad were slowest, and angry expressions were intermediate. In Experiment 2 (N = 67) we replicated our results for posed expressions and introduced a novel paradigm to index communicative emotional expressions. Across Experiments 1 and 2, we demonstrate differences between posed, spontaneous, and communicative expression contexts. Whereas mouth and eyebrow movements reliably distinguished emotions for posed and communicative expressions, only eyebrow movements were reliable for spontaneous expressions. In Experiments 3 and 4 we manipulated facial expression speed and demonstrated a quantifiable change in emotion recognition accuracy. That is, in a discovery (N = 29) and replication sample (N = 41), we showed that speeding up facial expressions promotes anger and happiness judgments, and slowing down expressions encourages sad judgments. This influence of kinematics on emotion recognition is dissociable from the influence of spatial cues. These studies demonstrate that the kinematics of facial movements provide added value, and an independent contribution to emotion recognition.

  • Research Article
  • Cite Count Icon 41
  • 10.1016/j.appet.2010.12.012
Measuring thinspiration and fear of fat indirectly. A matter of approach and avoidance
  • Dec 21, 2010
  • Appetite
  • Marcella L Woud + 3 more

Measuring thinspiration and fear of fat indirectly. A matter of approach and avoidance

  • Discussion
  • 10.1097/prs.0000000000001190
Severe traumatic facial injury: avatars and thermographic damage evaluation.
  • May 1, 2015
  • Plastic and reconstructive surgery
  • Ricardo Horta + 4 more

Sir: An ideal method for evaluating facially disfigured patients should combine morphologic analysis and dynamic evaluation. We analyzed a 17-year-old male patient with sequelae of facial trauma caused by a motorcycle accident (Fig. 1). He underwent multiple reconstructive procedures, but a disfigured face remains and further operations are needed.Fig. 1: Severe facial trauma in the context of a motorcycle accident without a helmet. Severe disfiguration in the scalp, frontal area, brow, eyelids and middle third of the face was present.First, we conceived three-dimensional facial avatars using two different approaches: (1) a moving low-cost RGB-D device for low-resolution results (Kinect; Microsoft Corp., Redmond, Wash.), and (2) a single-shot method taken from multiple high-resolution cameras synchronized and configured in stereoscopic pairs. This system creates an animatable three-dimensional facial model that resembles a real person. The process is divided into three steps: (1) acquisition, (2) retopology, and (3) texture transfer. [See Figure, Supplemental Digital Content 1, which shows an overview of the pipeline. (Left) Input RGB and depth maps. (Second from left) Three-dimensional mesh reconstruction. (Second from right) Alignment of the scanned mesh with our template. (Right) Texture computation, https://links.lww.com/PRS/B283.] The first deals with the three-dimensional data gathering, which allowed us to create the subject virtual face model. The second (retopology) is the conversion process to a “ready-to-animate” model, fitting the template of a generic mesh to the acquired three-dimensional mesh. Last, the texture transfer method computes the new texture, which is adjusted to the avatar’s mesh. Thermographic measurements were taken posteriorly. The thermography camera used was a FLIR SC7000 (FLIR Systems, Wilsonville, Ore.) with a hot metal colored lens filter that was previous configured to a 30° to 40°C temperature range. The subject sat on a chair at a distance of 1.5 m from the camera. He was asked to perform four facial expressions: facial expression at rest, with eyes closed, with eyes wide open, and while smiling. Data management was performed with Altair 5.91.010 software (FLIR Systems). An analysis mask was established over the facial areas of interest: (1) right forehead, (2) left forehead, (3) right orbit, (4) left orbit, (5) nose, (6) right labial commissure, (7) left labial commissure, and (8) mouth. For each area, the mean temperature and its standard deviation were calculated, as were the maximum and minimum values (Table 1).Table 1: Values Recorded in Each Area Represented by Its Order Number during the Facial Expressions*In addition to a detailed analysis of the facial dynamics, three-dimensional models analyzed with MeshLab (“Alessandro Faedo” Institute of Information, National Research Council, Pisa, Italy) allowed for a morphologic study and direct measurements. This avatar showed persistent ectropium and a significant change in vertical height of the palpebral fissure on the left side (Fig. 2). In the frontalis muscle contraction exercise, we have observed asymmetry and gross brow hairline distortion. (See Figure, Supplemental Digital Content 2, which shows frontalis muscle contraction, https://links.lww.com/PRS/B284.) When ordering palpebral voluntary closure, the patient could not completely close his left eyelid. The problems seem to affect mainly the upper and middle thirds of the face, as good excursion of the oral commissures was seen.Fig. 2: Creation of a three-dimensional face avatar and analysis with MeshLab v.1.3.2. Direct measurements such as maximal eyelid aperture are possible.Concerning thermographic analysis, when comparing the measures to a control group (28 normal subjects), he showed a persistent tendency for contralateral thermal asymmetries, with the highest values of surface temperature on the right side, and the highest values on the right forehead area. [See Figure, Supplemental Digital Content 3, which shows average temperature and standard deviation (area 1) and left (area 2) forehead areas during the four facial expressions (patient 1). The hatched bars represent the mean values and standard deviations of the control group for the same task, https://links.lww.com/PRS/B285.] Surface temperature reduction on the left labial commissure was also seen. (See Figure, Supplemental Digital Content 4, which shows smiling analysis, https://links.lww.com/PRS/B286.) These findings were probably a consequence of muscular damage, fibrosis, facial nerve paralysis, and decrease of the regional blood flow. These technologies could have a place in the management of facially disfigured patients, and further studies are needed. PATIENT CONSENT The patient provided written consent for the use of his images. DISCLOSURE None of the authors has a financial interest in any of the products or devices mentioned in this article. Ricardo Horta, M.D. Rita Valença-Filipe, M.D. Ricardo Nascimento, M.D. Alvaro Silva, M.D. José Manuel Amarante, M.D., Ph.D. Department of Plastic, Reconstructive, and Maxillofacial Surgery, and Burn Unit Centro Hospitalar de São João Porto Medical School Porto, Portugal

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