A prospective cohort study assessing differences in cosmetic appreciation of lateralization while smiling in patients with a peripheral facial palsy.

We investigated the differences in cosmetic appreciation of patients with a left and a right peripheral facial palsy (PFP) while smiling. Smiling pictures of patients with a facial palsy with House-Brackmann II-VI were reversed as a mirror image and offered as a pair of pictures, together with the true image. Twenty-six patients with a PFP and 24 medical professionals familiar with facial palsy were asked to choose the most attractive photograph. Patients rated their own pictures. Medical professionals preferred pictures of patients with a right and left PFP in, respectively, a mean of 43.00 +/- 12.25% and 57.00 +/- 12.28% (p = .005). Patients with a right PFP chose their mirror and true image in 65% and 35% in smiling pictures (p = .01). Patients with a left PFP facial palsy chose their mirror and true image in 58% and 42% in smiling pictures (p = .02). The House-Brackmann score and age of the patients did not influence preferences of medical professionals and patients. We have found that medical professionals have a significant preference for pictures of patients with a left PFP. Patients with a left PFP and right PFP significantly prefer their mirror image in smiling pictures.