The aim of this study was to evaluate the differences in the assessment of surgical aesthetic facial outcomes of treated cleft individuals by raters of variable backgrounds. Cleft lip and palate patients undergo extensive surgical procedures from birth to adolescence in order to restore function and aesthetics. However, these surgical procedures may result in substantial scarring and disfigurement. Several studies have compared subjective assessments of treatment outcomes between professionals and laypeople [14, 21, 22]. But limited literature exists when it comes to comparing the ratings of treatment outcomes between laypeople and professionals of different backgrounds, including orthodontics and dentofaical orthopaedics, oral and maxillofacial surgery, and plastic surgery.
In the present study, professionals rated treatment outcomes significantly lower than laypeople rated outcomes. This can be attributed to the fact that professionals are more aware of the surgical techniques and gold-standard surgical procedures, which makes them less tolerant of undesirable aesthetic results. This is in contrast with previous studies where there were no differences between the ratings of professionals and laypeople [3, 23, 24]. The different findings could be attributed to the dissimilarity of the rating panels. In the other studies, the rating panels mainly comprised surgeons and laypeople, where the raters in the present study included orthodontists, oral and maxillofacial surgeons, and plastic surgeons, and the lay raters included parents of the cleft-affected individuals. The difference in the panel groups may have affected the aesthetic ratings. However, the rating groups of the present study may produce more representative aesthetic ratings as it accounts for the different professionals of the cleft team who are the most involved group during the course of treatment for these patients, and in fact influence the type and course of therapy. Further studies with a greater number of raters from various cleft team professionals are warranted in order to test the validity of our findings.
Male participants perceived treatment outcomes as significantly less attractive than female participants perceived. Sinko et al. studied different gender perceptions of cleft-affected individuals [3]. They found that female patients with a cleft rated their own facial appearance significantly less than their male counterparts. This could be attributed to the effect of mass media and societal norms in prioritizing females’ physical attractiveness. However, in the present study, male and female raters were not cleft-affected and did not rate their own facial appearance. Instead, they rated other cleft individuals. Limited literature exists on the gender differences in aesthetic perceptions, and further investigations are required.
As for the need for corrective surgery, professionals perceived a greater need for corrective surgery than laypeople. This could be linked to the low treatment expectations of the lay raters and the low perceived influence of cleft lip and palate on social interactions and professional life, thus reflecting a good social acceptance of CLP patient by the general population. Out of the professional panels, plastic surgeons deemed more need for further corrective surgery. This finding is in agreement with Foo et al. [25], who studied the differences between surgical professionals (plastic surgeons) and non-surgical professionals (orthodontist, dentist, and psychologist). Plastic surgeons also had the lowest mean in their assessment of the success of the surgery. This could be a result of the increased treatment options of nose correction and scar remodelling in the field of plastic surgery.
The negative correlation found in the present study between low aesthetic assessments and increased perceived effect of CLP on social interactions and professional life may be associated with the consistent research findings in social sciences that clearly link appearance with social stereotyping and expectations [26, 27].