Context-dependent aesthetic perception after facial local flap reconstruction for cutaneous malignancies: a...

Local flaps are fundamental for reconstruction of facial defects after cutaneous tumor resection, yet perceived aesthetic success may differ among surgeons, patients, and the general public.

To investigate context-dependent aesthetic perception across facial regions and evaluator groups and its relationship with patient-reported FACE-Q outcomes.

Twenty-three patients undergoing local flap reconstruction after facial tumor resection were evaluated using preoperative and 12-month postoperative photographs. Overall, 203 evaluators-plastic surgeons, non-plastic surgeons, non-surgical physicians, and the general public-rated outcomes on a five-point scale, first using postoperative images alone and subsequently after viewing corresponding preoperative photographs. FACE-Q Face Overall, Natural Appearance, and Psychological Function scales were assessed preoperatively and postoperatively.

Preoperative context resulted in significantly more critical ratings across perioral, periocular, and malar regions (all p<0.001). Perceptual shifts differed among evaluator groups in perioral (p=0.007) and periocular (p=0.015) regions, with plastic surgeons showing smaller shifts. FACE-Q Face Overall and Natural Appearance scores improved significantly postoperatively. A study-specific summary score derived from the three selected FACE-Q scales was significantly associated with general-public ratings (ρ = -0.56, p = 0.008).

Aesthetic assessment after facial local flap reconstruction is context-dependent. Integrating FACE-Q patient-reported outcomes with public perception may provide a more patient-centered assessment of reconstructive success.