UNCORRECTED PROOF Differential judgements about disfigurement: the role of location, age and gender in decisions made by observers * Matthew D. Gardiner a, *, Ashley Topps a , George Richardson a , Amanda Sacker b , Alex Clarke a , Peter E.M. Butler a a Department of Plastic and Reconstructive Surgery, Royal Free Hospital, Pond Street, London NW3 2QG, UK b Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK Received 4 December 2007; accepted 30 July 2008 KEYWORDS Body image; Disfigurement; Facial lesion; Psychology Summary Psychological distress associated with disfiguring facial lesions is common. However, whilst the intrusive behaviour of observers is commonly reported, for example, staring, comments and questions, these factors which may influence the judgements of observers have not been well described. This is important as it may influence a subject’s perception of how their appearance is viewed by the external world. This study is the first to investigate age and gender differences when measuring the impor- tance of location in judgements about facial disfigurement. Observers were asked to rank the impact of simulated lesions in different positions on the face of Caucasian subjects. Age and gender varied in both groups. Our results show that lesions on the young and female subjects are ranked as having a greater impact than those on the old and male subjects. Lesions on central facial features have a higher impact than those located more peripherally. Both of these findings were not significantly influenced by observer age or gender. These results are discussed in terms of culturally derived attributions about appearance. It is also suggested that there is a scope to use feedback on how disfigurement is viewed by others as a therapeutic tool in clinical settings. ª 2008 Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons. Facial disfigurement can be congenital or can arise as a result of trauma or disease. It is associated with variable aesthetic, functional and psychological morbidity, with no evidence that the severity of a disfigurement predicts psychological distress. 1 Rather, the impact of a disfiguring * This work has been partly presented at the Centre for Appear- ance Research: Appearance Matters 2 conference, Bath, UK 2006. * Corresponding author. Department of Plastic and Reconstruc- tive Surgery, Royal Free Hospital, Pond Street London NW3 2QG, UK. Tel.: þ44 7870619627. E-mail address: mdgardiner@gmail.com (M.D. Gardiner). ARTICLE IN PRESS 1748-6815/$ - see front matter ª 2008 Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons. doi:10.1016/j.bjps.2008.07.043 Journal of Plastic, Reconstructive & Aesthetic Surgery (2008) xx,1e5 + MODEL 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 PRAS1430_proof  21 November 2008  1/5 Please cite this article in press as: Matthew D Gardiner et al., Differential judgements about disfigurement: the role of location, age and gender in decisions made by observers, J Plast Reconstr Aesthet Surg (2008), doi:10.1016/j.bjps.2008.07.043