The Effect of Wearing a Mask on Facial Attractiveness

Research Brian Bassiri-Tehrani, MD; Alvin Nguyen, BS; Akriti Choudhary, MBBS ; Jiddu Guart, MD; Bianca Di Chiaro, MD; and Chad A. Purnell, MD Abstract Background: The COVID-19 pandemic necessitated masking in public spaces. Masks may impact the perceived attractive ness of individuals and hence, interpersonal relations. Objectives: To determine if facial coverings affect attractiveness. Methods: An online survey was conducted using 114 headshot images, 2 each—unmasked and masked—of 57 individuals. Two hundred and seven participants rated them on an ordinal scale from 1 (least attractive) to 10 (most attractive). Parametric and nonparametric tests were performed, as appropriate, for comparison. Results: For the first quartile, the average rating increased significantly when wearing a mask (5.89 ± 0.29 and 6.54 ± 0.67; P = 0.01). For control images ranked within the fourth quartile, the average rating decreased significantly when wearing a mask (7.60 ± 0.26 and 6.62 ± 0.55; P < 0.001). In the female subgroup (n = 34), there was a small increase in average rating when masked, whereas in the male subgroup (n = 23), there was a small decrease in average rating when masked, but the change was not statistically significant (P > 0.05). For unmasked female images ranked within the first quartile, the average rating increased significantly when wearing a mask (5.77 ± 0.27 and 6.76 ± 0.36; P = 0.001). For the female subgroup with mean ratings within the fourth quartile, the average decreased significantly when wearing a medical mask (7.53 ± 0.30 and 6.77 ± 0.53; P < 0.05). For unmasked male images ranked within the first quartile, the average rating increased when wear ing a medical mask but the change was not statistically significant (P > 0.05), whereas for the control male images within the fourth quartile, the average rating decreased significantly when masked (7.72 ± 0.18 and 6.50 ± 0.54; P < 0.05). Conclusions: While wearing a facial covering significantly increased attractiveness for images less attractive at baseline, and decreased attractiveness for those that are more attractive at baseline; it did not cause a significant overall change in attractiveness in the study population. Level of Evidence: 5 Editorial Decision date: August 1, 2022; online publish-ahead-of-print September 2, 2022. Dr Bassiri-Tehrani is an aesthetic plastic surgery fellow, The Center for Plastic Surgery at MetroDerm/Emory Aesthetic Center, Atlanta, GA, USA. Mr Nguyen is a medical student; Dr Choudhary is a research fellow; and Dr Purnell is an assistant professor, Division of Plastic, Reconstructive & Cosmetic Surgery University of Illinois College of Medicine, Chicago, IL, USA. Dr Guart is a postgraduate year 2 resident, Division of General Surgery, Brown University, Providence, RI, USA. Dr Di Chiaro is a postgraduate year 3 resident, Division of Plastic & Reconstructive Surgery, Loyola University Medical Center, Chicago, IL, USA. Corresponding Author: Dr Chad A. Purnell, Division of Plastic Reconstructive & Cosmetic Surgery, University of Illinois College of Medicine, 811 S Paulina St, Chicago, IL 60612, USA. E-mail: The Effect of Wearing a Mask on Facial Attractiveness Aesthetic Surgery Journal Open Forum 2022, 1–10 © The Author(s) 2022. Published by Oxford University Press on behalf of The Aesthetic Society. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https:// creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. https://doi.org/10.1093/asjof/ojac070 www.asjopenforum.com 2 The pre-pandemic effect of partial occlusion of the lower half of the face on the perceived attractiveness of female faces was demonstrated in the Japanese pop ulation by Miyakazi et al in 2016.20 They demonstrated an “occlusion effect” vs a “sanitary mask effect,” specific to medical masks. In this study, medical masks in partic ular resulted in decreased attractiveness compared to occlusion with other objects, presumably due to the as sociation of illness with wearing a mask. Kamatani et al, in 2021, demonstrated the role of the global pandemic in eliminating the “sanitary mask effect” due to the ubiquity of masks.21 Similarly, other studies conducted in Canada,22,23 UK,24 and Spanish-speaking countries25 have attempted to understand the association of partial facial occlusion (by masking, control objects and image manipulation) with per ceived attractiveness, and its interaction with base attrac tiveness of nonoccluded faces. Patel et al26 conducted a larger survey in 2020 at a time when the global population was starting to acclimate to the mandated widespread practice of wearing facial coverings. After having experienced multiple surges of the COVID-19 pandemic, facial masking is now a commonplace practice in public spaces and a routine part of one’s daily life. We con ducted a crowdsourcing-based cross-sectional study in October 2021, to assess the perception of masked facial at tractiveness at this stage of the pandemic, when one sees a large proportion of strangers using face masks and is rela tively comfortable with the practice. The primary aim of our study is to evaluate to what extent, if any, wearing a mask af fects facial attractiveness. Our secondary aim is to deter mine if cohorts that are perceived the least or most attractive at baseline were differently affected by wearing a mask. For crowdsourcing, we utilized Amazon Mechanical Turk (MTurk, [Amazon Web Services, Amazon, Seattle, WA]), which has been used in the past as an effective platform for online crowdsourcing in scientific and nonscientific applica tions.27-29 It provides a more economical, faster, and anony mous method of recruiting participants as compared to prospective longitudinal enrolment.30 Moreover, it offers a population self-reported as being representative of the US population with respect to gender, race, age, and educational qualifications.27,30-32 In the field of plastic surgery, MTurk has been previously utilized to assess public perception of aes thetic features.33-36 METHODS We designed a cross-sectional survey to compare per ceived attractiveness between unmasked and masked im ages of the same individuals. An a priori power analysis determined that a minimum of 100 total photographs would be needed (50 unmasked and 50 masked) in order to Physical attractiveness has social consequences; thus, anything that can potentially interfere with or augment fa cial beauty is important to interpersonal relationships. It has been well described that people who are perceived as good-looking benefit from a beauty bias or “halo” effect.1 They are more successful in dating aspirations, making new friends, ascending professional careers, and being ex onerated for crimes compared with their less attractive counterparts.1 In a study, Maestripieri et al. offers an (...truncated)