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Response to Letter to the Editor: Where Do We Look? Assessing Gaze Patterns in Cosmetic Facelift Surgery with Eye Tracking Technology.

451e We also agree that the large difference in Likert scores as assessed by cosmetic attending plastic surgeons are less relevant to real-world situations and that the Likert scores from laypersons are likely more reflective of real-world assessments. In considering the evaluation by laypersons, the small Likert score difference combined with the central-face gaze patterns again suggest that the aesthetic changes of a face-lift procedure may be only subtly perceptible to the viewer. It would be interesting to compare the relative impact from aesthetic procedures of the central face versus the peripheral face (e.g., rhinoplasty versus face lift) and how they alter gaze patterns. As Rajesh et al.’s comments suggest, this could similarly be used to help identify patients who would benefit the most from preoperative counseling. Although other studies have suggested that participants be shown a particular patient only once to decrease the possibility of priming bias, we feel that this would make comparisons between preoperative and postoperative images less indicative of the procedure’s direct effect on participant perception. Asking participants to evaluate both the preoperative and the postoperative image allows for a direct measurement of that participant’s perceptions of the change based on the procedure. We thank Rajesh et al. for the suggestions for potential future directions for these studies. It would be particularly interesting to assess gaze patterns in video recordings, or perhaps even face-to-face interactions, to more closely approximate real-world interactions. We appreciate the opportunity to respond to their letter regarding this article. DOI: 10.1097/PRS.0000000000006437