Application and outcomes of eye tracking technology in the field of plastic surgery

Staiger, Tim Jann (2023): Application and outcomes of eye tracking technology in the field of plastic surgery: recommendations and outlook in light of current studies. Dissertation, LMU München: Medizinische Fakultät

Abstract

The present cumulative dissertation deals with the application and relevance of eye tracking in plastic surgery. Eye tracking has already established itself as a successful and objective assessment method in several fields (11,13). Potential importance of eye tracking for plastic surgery lies in providing additional objective assessment methods to evaluate results more accurately to optimize success. This dissertation considers eye tracking as an interesting method for measuring gaze patterns. Emphasis is placed on visual behavioral analysis and the change of attention upon viewing a given stimulus. In particular, it examines how eye tracking technology can be used to improve pre- and postoperative patient consultation. In this context, two frequently used surgical techniques with a steadily growing interest are examined in more detail. The study aims to provide an informed assessment of the effectiveness and relevance of eye tracking in plastic surgery for optimizing patient satisfaction and outcomes. The first study addresses the identification of the most aesthetically pleasing umbilical position in the context of abdominoplasty using objective and subjective assessment methods by combining eye tracking technology with a subjective 5 - point Likert scale. Previous studies have mainly focused on surgical techniques, with little attention given to the position itself and its aesthetics. The few studies that were concerned with it have mostly employed bony landmarks of the pelvis (pubic symphysis and spina iliaca anterior superior) and worked with absolute values (in cm) for the repositioning of the umbilicus. In the present study, however, the placement of the navel positions was based on ratios, which leads to an improved practical application and allows an individual adaptation to the patient's needs. The results illustrate that the navel position with an XU:UC ratio of 2:1 received the highest subjective rating, while the position with a ratio of 5.5:1 was rated as least attractive. Interestingly, it was found that the time until first fixation, which is the time when the subject directs their gaze to the umbilical position, was shorter for the positions that were perceived as unattractive. In addition, the total fixation time was relatively long for such positions. Furthermore, it is noteworthy that aes- thetically pleasing umbilical positions were viewed both shorter and later overall. The Data suggest that a navel position that is perceived as unattractive attracts attention faster and longer. Given the results indicating that the navel position with a 2:1 ratio was rated as the most attractive both subjectively and objectively, it can be concluded that this positioning should receive attention in clinical practice. These findings provide important insights for plastic surgery and contribute to improving the aesthetic results of the procedure, as well as allowing for a more individualized design of the umbilical position based on the needs and preferences of the patient. This second study investigates gaze behavior when viewing pre- and postoperative images of patients who had undergone blepharoplasty. It can be observed that the order of facial recognition changed pre- to postoperatively, with the peri-orbital area being prioritized prior to the procedure. The length of time spent viewing the periorbital region decreased significantly from 2.2 to 1.26 sec. after sur- gery (p < 0.05). The time to first fixation significantly prolonged for the postoperative periorbital region 0.81 to 1.84 sec. (p < 0.05). There were no significant changes for the periorbital and nasal regions. The study illustrates that the preferences of the beholder results in a change in the sequence of observation for facial areas, whereby aesthetically pleasing features are perceived at a later stage. Furthermore, the study highlights that the total duration and time of fixation provide valuable insights into perceived attrac- tiveness. By examining gaze behavior when viewing pre- and post-operative im- ages, changes in the sequence of facial recognition were detected, which directly informs aesthetic consultation and surgical planning. The results of both studies can best be explained by the concept of the "Internal Representation of Beauty", whereby objects and features that conform to this "internal standard" of beauty require less effort to be perceived and processed by the subject. A more attractive object or feature therefore draws less attention be- cause it corresponds to and fulfills the observer's criteria of judgement. The present studies deliver evidence for this concept (38). The findings of this study on visual behavior analysis provide a valuable method for quantifying and comparing outcomes as well as different therapeutic procedures in the aesthetic field. In summary, it appears that visual attention illustration through eye tracking allows for improved pre- and postoperative patient counselling. By allowing patients to see which areas of the face or body attract the most attention, realistic expectations and goals can be established. This enhances patient satisfaction and pro- motes effective communication between doctor and patient. Moreover, eye tracking enables customized surgical planning that is attuned to patients' unconscious needs and desires. By taking into account the patient's visual preferences and tastes, aesthetic procedures can be tailored to achieve the desired results. As a result, personalized treatment and a higher level of patient satisfaction can be obtained. Collectively, these conclusions show that the integration of eye tracking into aes- thetic surgery is a valuable resource to improve patient counselling, facilitate cus- tomized surgical planning and, ultimately, deliver more successful aesthetic procedures.

• Dokumententyp: Dissertationen (Dissertation, LMU München)
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften ; 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• Fakultäten: Medizinische Fakultät
• Sprache der Hochschulschrift: Deutsch
• Datum der mündlichen Prüfung: 17. Mai 2023
• 1. Bericht­erstatter:in: Giunta, Riccardo