Objective: To examine the changes in visual attention influenced by facial angles and smile during the evaluation of facial attractiveness. Materials and Methods: Thirty-three young adults were asked to rate the overall facial attractiveness (task 1 and 3) or to select the most attractive face (task 2) by looking at multiple panel stimuli consisting of 08, 158, 308, 458, 608, and 908 rotated facial photos with or without a smile for three model face photos and a self-photo (self-face). Eye gaze and fixation time (FT) were monitored by the eye-tracking device during the performance. Participants were asked to fill out a subjective questionnaire asking, ''Which face was primarily looked at when evaluating facial attractiveness?'' Results: When rating the overall facial attractiveness (task 1) for model faces, FT was highest for the 08 face and lowest for the 908 face regardless of the smile (P, .01). However, when the most attractive face was to be selected (task 2), the FT of the 08 face decreased, while it significantly increased for the 458 face (P, .001). When facial attractiveness was evaluated with the simplified panels combined with facial angles and smile (task 3), the FT of the 08 smiling face was the highest (P, .01). While most participants reported that they looked mainly at the 08 smiling face when rating facial attractiveness, visual attention was broadly distributed within facial angles. Conclusions: Laterally rotated faces and presence of a smile highly influence visual attention during the evaluation of facial esthetics. (Angle Orthod. 2018;88:329-337).
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