Assessment of the Influence of "other-Race Effect" on Visual Attention and Perception of Attractiveness before and after Rhinoplasty

Halley Darrach, Lisa E. Ishii, David Liao, Jason C. Nellis, Kristin Bater, Roxana Cobo, Patrick J. Byrne, Kofi D.O. Boahene, Ira D. Papel, Theda C. Kontis, Masaru Ishii

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


Importance: The "other-race effect" describes the phenomenon in which individuals demonstrate greatest recognition ability among faces of their own race. Thus, in our multicultural world, it follows that race influences social interactions. However, the association of race with perception of plastic surgery outcomes has not been studied. Objective: To objectively measure how the other-race effect influences perception of white and Latin American patients undergoing rhinoplasty by using eye-tracking technology and survey methodology. Design, Setting, and Participants: In the first part of the study, 134 participants viewed 32 paired facial images of white and Latin American patients, either prerhinoplasty or postrhinoplasty, on an eye-tracking system that recorded observer scan paths. In the second part of this study, the same patient images were individually graded by a separate group of 134 participants for degree of racial identification and perceived attractiveness. Main Outcomes and Measures: The primary outcome was to measure the influence of patient and observer race on perception of rhinoplasty outcomes. For the eye-tracking part, planned hypothesis testing was conducted using an analysis of variance to compare patient race, rhinoplasty status, and attractiveness with respect to visual fixation time. Results: Of the 134 eye-tracking participants, 68 (51%) were women and the mean (SD) age was 26.4 (7.7) years; of the 134 graders, 64 (48%) were women and the mean (SD) age was 25.0 (6.9) years. Rhinoplasty did not affect racial identity scores among either same-race or other-race evaluators. Visual fixation times for white faces were significantly increased compared with Latin American faces among all casual observer groups (white observers mean change, -20.14 milliseconds; 95% CI, -29.65 to -10.62 milliseconds; P <.001; Asian observers mean change, -39.04 milliseconds; 95% CI, -48.95 to -29.15 milliseconds; P <.001; and African American observers mean change, -20.73 milliseconds; 95% CI, -37.78 to -3.69 milliseconds; P <.02), with the exception of Latin American observers (mean change, -7.8 milliseconds; 95% CI, -29.15 to 14.39 milliseconds; P <.51). With respect to attractiveness, white graders reported a significant postrhinoplasty increase across both races (white patients mean change, 8.07 points; 95% CI, 5.01-11.12 points; P <.001; and Latin American patients mean change, 3.69 points; 95% CI, 0.87-6.49 points; P =.01), whereas Latin American graders only observed a significant attractiveness increase in their own race (Latin American patients mean change, 10.50 points; 95% CI, 1.70-19.32 points; P =.02). Neither perceived attractiveness nor rhinoplasty status influenced fixation times. Conclusions and Relevance: Both patient and observer race influence visual attention and perception of attractiveness before and after rhinoplasty. These findings underscore the importance of counseling patients that the influence of rhinoplasty, as perceived by the casual observer, may vary by race or ethnicity of the observer group. Level of Evidence: NA..

Original languageEnglish (US)
Pages (from-to)96-102
Number of pages7
JournalJAMA Facial Plastic Surgery
Issue number2
StatePublished - Mar 1 2019

ASJC Scopus subject areas

  • Surgery


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