Abstract

The evaluation of gender-affirming facial feminization surgery (FFS) outcomes can be highly subjective, which has resulted in a limited understanding of the social perception of favorable gender and aesthetic facial appearance following these procedures. The growing use of eye-tracking technology in the assessment of surgical outcomes has introduced an objective measure of viewer subconscious gaze, which may provide more insight into how viewer characteristics may influence gaze, attention and perception of favorable FFS outcomes.In this study, eye-tracking technology was used to measure attention and perception of surgery naïve cisgender female and feminized transgender faces, based on viewer gender identity.Thirty-two participants (18 cisgender and 14 transgender) were enrolled and shown five photos each of surgery naïve cisgender female and feminized transgender faces. Gaze was captured using the Tobii X2 60 eye-tracking device (Tobii, Stockholm, Sweden) and participants rated the gender and aesthetic appearance of each face using Likert-type scales.Total image gaze fixation time did not differ by participant gender identity (6.00 vs 6.04 sec, p = 0.889), however, transgender participants spent more time evaluating the forehead/brow, buccal/mandibular regions and chin (p < 0.001). Multivariate regression analysis showed significant associations between viewer gender identity, age, race, and education and the time spent evaluating gender salient facial features. Feminized faces were rated as more masculine with poorer aesthetic appearance than surgery naïve cisgender female faces, however, there was no significant difference in the distribution of gender appearance ratings assigned to each photo by cisgender and transgender participants.These results demonstrate that gender identity influences subconscious attention and gaze on female faces. Even so, differences in gaze distribution did not correspond to subjective rated gender appearance for either surgery naïve cisgender female or feminized transgender faces, further illustrating the complexity of evaluating social perception of favorable FFS outcomes.

View details for DOI 10.1093/asj/sjaa377

View details for PubMedID 33336697