Reply: Where Do We Look? Assessing Gaze Patterns in Cosmetic Face-Lift Surgery with Eye Tracking Technology.

Abstract

Sir: We thank the authors for their interest in our article on assessing gaze patterns in cosmetic face-lift surgery with eye-tracking technology and for your thoughtful comments on our study.1 We agree that one must be cautious in drawing conclusions about the different gaze patterns between laypersons and trained experts when evaluating outcomes of a face-lift procedure. The differences in gaze patterns could certainly be a function of a viewer’s interpretation of the task, which may vary based on one’s expertise. It is conceivable that a trained surgeon would focus on the technical success of an operation, whereas a layperson would take a more holistic view of the face. However, we feel that these patterns should be treated not as variations in interpreting the task, but rather as an implicit bias of one’s training. Given that one often calls on these implicit biases when examining faces in a real-world setting, it seems appropriate that these biases be similarly reflected in an eye-tracking study. However, to minimize such ambiguity in future studies, a more rigidly defined view task may help eliminate such ambiguity between participant cohorts. We were similarly interested to see the large amount of fixation time spent on the nose, in contrast to prior studies that have shown the eyes to be the site of greatest fixation. On review of our data, we found that expert viewers trended toward longer fixation durations as compared to laypersons, but this was not statistically significant. Given these variations as compared to prior studies, we agree that it would be prudent to include fixation durations in addition to fixation counts in future studies. Some of these discrepancies may also stem from small differences in how areas of interest for a particular region are marked by different researchers. As such, it would certainly be beneficial to future eye-tracking studies to have more standardized reporting methods and facial regions. We appreciate the opportunity to respond to the authors’ letter regarding this article and are excited to see how future work in eye-tracking can inform clinical decisions in plastic surgery. ACKNOWLEDGMENTS This study was supported by the Stanford School of Medicine, MedScholars Research Program. The authors thank the Tobii Group for the generous use of their eye-tracking hardware and software for this study. DISCLOSURE None of the authors has a financial interest in any of the products or devices mentioned in this communication.