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Personality, Success, And Beyond: The Layperson's Perception Of Face Transplant Patients
Mya Abousy, BA, Hillary Jenny, MD, Helen Xun, BS, Nima Khavanin, MD, Francis Creighton, MD, Patrick Byrne, MBA, MD, Damon Cooney, MD, Richard Redett, MD, Robin Yang, DDS, MD.
Johns Hopkins University School of Medicine, Baltimore, MD, USA.

PURPOSE: Though the field of face transplants is nascent, with only around forty procedures to date, its impact on patient life cannot be understated. While the goal of this procedure is to provide patients with improved physical and social function, research evaluating how face transplant patients are perceived by laypeople is lacking. The purpose of this study was to determine how face transplant changes social acceptance and perceived career success of patients with facial disfiguration, and how they compare to people without history of facial trauma.
METHODS: 815 laypersons were surveyed through Mechanical Turk to evaluate their perceptions of face transplant patients. Respondents were shown photographs of faces of a female and male facial trauma patient pre- and post-face transplant, and of an individual without facial disfigurement of a similar demographic to each patient as a control. Each photograph was followed by 26 items to evaluate the individual on a Likert scale from 1 to 5. The respondents rated 10 personal characteristics (intelligent, competent, employable, capable, trustworthy, self-conscious, kind, extroverted, happy, attractive), 8 experiences (discrimination, teasing, social isolation, romantic relationships, psychiatric illness, friendship, committing a crime, dependence on welfare), 3 interactions (avoiding and befriending patient, degree of comfort with patient), and 5 professional success items (high school, college, and professional degree, income > $100,000, leader in job). Responses were ruled out if they did not pass the attention checks or if the survey was completed in less than six minutes. Responses were analyzed using descriptive statistics and the Wilcoxon Signed-Rank test.
RESULTS: Overall, both male and female post-transplant patients were perceived as significantly more socially accepted and professionally successful than their pre-transplant state (>21/26 items, p<.001 for all). However, the post-transplant patients scored lower than their control (>25/26 items, p<.001 for all). Interestingly, among the male photos, pre-transplant was perceived as kinder, more trustworthy, and less likely to commit a crime than post-transplant (p<.001), and post-transplant was perceived as kinder than control (p<.05). Among the female photos, pre-transplant was perceived as more intelligent than post-transplant (p<.05), but there was no statistically significant difference in competence or committing a crime (p>.05). When compared to control, post-transplant female showed no statistically significant difference in likelihood of committing a crime (p>.05).
CONCLUSIONS: This study suggests that face transplants have a significantly positive impact on social acceptance and perceived professional success. However, as post-transplant patients scored lower than their controls, this indicates that face transplants do not completely reinstate social acceptance and perceived professional success. Furthermore, the discrepancies in findings between cases and genders indicate that there are either varying surgical outcomes and/or cognitive biases (such as gender) that impact perceptions of the individual by the public. This is translatable to practice, as patients should be adequately counseled to set realistic expectations of outcomes, and that results are individually based. Within the face transplant provider community, the case-dependent varied public perceptions suggest a need to standardize practices to better predict and improve outcomes, and to adjust aesthetic techniques on patient factors such as gender.


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