The Facial Dissatisfaction Of Groups With Maxillofacial Plastic Surgery

Facial dissatisfaction,belonging to the face dimension of body image disturbance,is the negative cognition,the negative emotional experience and the corresponding behavioral regulation for the own faces of people.A large number of Chinese and western studies have investigated the body image disturbance about weight among high-risk groups and clinical groups.However,little is known about the body image disturbance about face.Human face plays an important role in the social life such as interpersonal communication and interaction.A lot of studies suggested that people with highly attractive faces had distinctly advantage in job hunting,mate selection and interpersonal communication.Current Chinese studies of body image disorder about face were mainly concentrated in high-risk groups with facial dissatisfaction,such as women with facial negative physical self.Few researches examined clinical groups with facial dissatisfaction.We studies people with maxillofacial plastic surgery(MPS)for their dento-maxillofacial deformities which may have negative impact on their facial attractiveness and result in body image disturbance about face.Study on the facial dissatisfaction among these patients may advantage our knowledge in three aspects.First,it may expand the western researches on body attractiveness to face attractiveness,which conforms more to the Chinese traditional culture and popular culture.Second,study on the facial dissatisfaction among clinical group may help develop the theory of body image disturbance from the dimension of weight to the dimension of face and from high-risk groups to clinical groups.Finally,it may contribute to the behavioral diagnosis of mental disorders about facial dissatisfaction,and provide theoretical and experimental evidence for correction of these disorders.In the current study,we investigated the facial dissatisfaction in people with MPS from the perspective of sociocultural and cognition through the approaches of questionnaire,psychophysical test and event related potential(ERP)technology.The current research consists of six studies,including 4 questionnaire and 8 behavioral experiments,to investigate the influence of sociocultural factors and cognitive factors on the facial dissatisfaction of groups waiting for MPS.In Study 1,we adopted questionnaire method to establish a predictive model,based on Tripartite Influence Model and the expansion of this model,to examine the role of sociocultural and psychological factors in the development and maintenance of facial dissatisfaction in clinical group.In Study 2 we used discriminant analysis to investigate whether sociocultural factors and psychological factors could effectively distinguish people in experimental group and control group.In Study 3,we took a revised dot probe paradigm to examine the attentional pattern towards different types of faces from the perspective of behavioral responses among MPS.Fisrstly,we used this paradigm conmbined eye tracking method to investigate attention pettern of faces among high-risk groups,in order to provide experimental and theoretical evidence for studying clinical group(MPS).Secondly,As faces was the stimuli,we had to take into account the facts that male faces and female faces had different values in the evolution and female faces played a more important role in mate selection.Thus,we used female faces and male faces in two experiments respectively to examine the evolutionary and cognitive factors in the facial dissatisfaction in clinical group.Note that the facial dissatisfaction in clinical group mainly resulted from dento-maxillofacial deformities.Thus in Study 4,a flicker paradigm was adopted and highly attractive(HA)faces,moderately attractive(MA)faces,lowly attractive(LA)faces and faces with dento-maxillofacial deformities(DMD)were used as stimuli.In each trial,an array of 8 faces was presented in random positions on the screen.Then in one of the 8 faces,a facial feature(e.g.,eyes,lips)disappeared and reappeared.Subjects were required to detect the face that changed as quickly as possible.In this study,we aimed to further validate the cognitive-behavior model in clinical group with facial dissatisfaction and examined their attention pattern towards female and male face features.In Study 5,we used ERP technology to investigate the time course of brain responses to different types of faces among clinical group with facial dissatisfaction.Subjects were required to judge facial attractiveness.The electrophysiological activities corresponding to female faces and male faces were examined in two experiments respectively.The studies above have not addressed the problem that whether the processing of highly attractive face was automatic or it needed attentional resources.Therefore,in Study 6,we tried to examine the brain responses of clinical group to different types of female and male faces in two experiments respectively with an implicit paradigm.Questionnaire results suggested that clinical group scored higher on appearance interpersonal pressure,appearance media pressure,upward and downward physical appearance comparison,fear of negative appearance evaluation,appearance conversation with friends,dentofacial aesthetics,facial dissatisfaction,concern about appearance and acceptance of cosmetic surgery than controls did.These sociocultural and psychological factors could also effectively distinguish the people in clinical group and control group.In the predictive models of the two groups,appearance interpersonal pressure and fear of negative appearance evaluation were the strongest predictors of facial dissatisfaction and had stronger effect in the model of clinical group compared to control group.Downward physical appearance comparison,rather than upward comparison,was a significant predictor.In the predictive model of clinical model,dentofacial aesthetics was still a significant predictor after controlling for these sociocultural factors.In the behavioral experiments,we studied the attention bias towards different types of faces.We found that in dot probe task,group waiting for MPS showed attentional avoidance to female faces with DMD compared to control group.They also showed attentional maintenance towards DMD male faces compared to highly attractive male faces.In covert orienting task of ERP study,clinical group had larger N1 and smaller LPC for DMD female faces than HA and LA female faces,compared with control group.They also had the smallest N1 for DMD male faces and had a larger LPC for DMD male faces than MA male faces and the LPC of controls.Both of the dot probe task and covert orienting task were judging the location of targets,which may have little relationship with the faces.Furthermore,in dot probe task,the response time was corresponding to the probes after stimuli disappeared.The attention pattern of stimuli was indirectly referred from such response times,making it hard to explore the time course of attention.Therefore,the attentional pattern of MPS group towards DMD faces in dot probe task may be corresponding to the late components in covert orienting task.These results indicated that MPS group showed early attention vigilance and late attention avoidance towards DMD female faces,and early attention avoidance and late attention maintenance towards DMD male faces.However,in facial attractiveness judgment tasks,MPS group showed larger LPC for DMD female faces than LA faces,and larger LPC for DMD male faces than HA faces.It seemed that when performing explicit attractiveness judgment,MPS group showed late attention maintenance towards DMD female and male faces.For attentional pattern towards HA faces,in implicit conditions MPS group showed no significant bias towards HA female faces than controls but stronger electrophysiological bias towards HA male faces,while in explicit conditions they showed attention avoidance to HA female and male faces.In addition,MPS group responded faster to the mouth changes of DMD female and male faces than that of HA and LA faces,but slower to the mouth changes of HA female and male faces than controls did.However,it should be noted that MPS group reacted faster to the mouth changes of DMD male faces than control group but not in DMD female faces,and all participants responded slower to mouth changes than eyes changes in female faces but not in male faces.These results suggested that MPS group showed attention vigilance towards the mouth of DMD female and male faces but attention avoidance to HA female and male faces.In conclusion,the facial dissatisfaction of MPS group may develop in following three ways: first,the dento-maxillofacial deformities of MPS group could directly lead to facial dissatisfaction;second,MPS group may feel more social pressure than controls on account of their physiological defect,which may further result in the development and maintenance of their facial dissatisfaction;third,MPS group showed cognitive bias towards defective faces,which may also promote the development and maintenance of their facial dissatisfaction,in line with the cognitive behavioral model of facial dissatisfaction among MSP group.In addition,cognitive factors might interact with sociocultural factors and the cognitive behavioral model of facial dissatisfaction in MPS group could be affected by evolutionary factors when they process the face pictures.