Facial reanimation surgery restores affect display.

OBJECTIVE: Assess the ability of facial reanimation surgery to restore affect display in patients with severe facial paralysis. STUDY DESIGN: Survey of healthy observers' perception of change in facial visage from preoperative to postoperative state. SETTING: Academic tertiary referral center. MAIN OUTCOME MEASURES: Observer graded affect display. METHODS: Ninety naive observers completed a survey with pictures of paralyzed faces, smiling and in repose, before and after surgery, as well as normal comparison faces. Observers characterized affect display of each face coded in primary affects from the Derogatis Affects Balance Scale. Results were analyzed with latent class analysis and regression using a three-class model. RESULTS: Preoperatively, paralyzed faces in repose were most likely to be considered negative (56.0%), then neutral (41.3%) and positive (2.7%). In this same cohort of patients in repose, reanimation surgery restored affect display to normal levels: decreasing negative classification (18.9%) and increasing neutral (53.4%) and positive (27.7%) classification. Hypothesis testing revealed no statistically significant differences in the mean classification probabilities for postoperative faces in repose versus normal faces in repose. The same analysis was performed for smiling faces, which showed marked improvement with reanimation surgery: decreasing negative (45.6%-11.7%) and increasing positive (26.2%-60.0%) classification. Despite this improvement, there were statistically significant differences in classification of postoperative smiling faces versus normal smiling faces. CONCLUSION: Facial reanimation surgery was associated with normalized affect display for faces in repose and improved affect display for smiling faces. These results provide evidence that facial reanimation improves the facial expression of emotion. Further assessment in additional contexts will help better characterize the ability of facial reanimation to mitigate the psychosocial burden associated with facial paralysis.