Facial Scars: Do Position and Orientation Matter?

Plast Reconstr Surg. 2022 Dec 1;150(6):1237-1246. doi: 10.1097/PRS.0000000000009728. Epub 2022 Sep 19.


Background: This study tested the core tenets of how facial scars are perceived by characterizing layperson response to faces with scars. The authors predicted that scars closer to highly viewed structures of the face (i.e., upper lip and lower lid), scars aligned against resting facial tension lines, and scars in the middle of anatomical subunits of the face would be rated less favorably.

Methods: Volunteers aged 18 years and older from the United States were recruited through Amazon's Mechanical Turk to complete a face rating survey. Scars were digitally added in different locations and orientations for a total of 14 unique scars added to each face. Each participant rated 50 different faces on confidence, friendliness, and attractiveness. Data were analyzed using linear mixed effects models.

Results: A total of 88,850 ratings [82,990 scarred (93.4 percent)] for attractiveness, friendliness, and confidence were analyzed. In univariate linear mixed effects models, the presence of a facial scar did not significantly impact attractiveness (β = 0.016, SE = 0.014, z = 1.089, p = 0.276). A second set of linear mixed effects models identified interactions between location, subunit placement, and orientation to facial tension lines. Scars located on the lower lid mid subunit perpendicular to facial tension lines were rated less attractive (β = -0.065, SE = 0.028, z = -2.293, p = 0.022).

Conclusions: On average, a single well-healed facial scar does not negatively affect first impressions of attractiveness, confidence, or friendliness. Specific scar location and orientation combinations, however, such as a perpendicular scar at the mid-lower eyelid, may result in lower perceived attractiveness, confidence, and friendliness.

Clinical question/level of evidence: Risk, III.

MeSH terms

  • Attitude
  • Beauty
  • Cicatrix* / etiology
  • Face*
  • Humans
  • Lip
  • Surveys and Questionnaires