{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T16:39:01Z","timestamp":1788194341418,"version":"build-2803163510"},"reference-count":13,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2013,10,2]],"date-time":"2013-10-02T00:00:00Z","timestamp":1380672000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2014,4]]},"abstract":"<jats:sec><jats:title>Objectives\/Hypothesis<\/jats:title><jats:p>To quantify the threshold for human perception of asymmetry for eyebrow elevation, eye closure, and smile, and to ascertain whether asymmetry detection thresholds and perceived severity of asymmetry differ in distinct facial zones.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>Online survey.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Photographs of a female volunteer performing eyebrow elevation, eye closure, and smile were digitally manipulated to introduce left\u2010to\u2010right asymmetry in 1\u2010mm increments from 0 mm to 6 mm. One hundred and forty\u2010five participants viewed these photographs using an online survey, measuring accuracy of asymmetry detection and perceived expression unnaturalness (on a scale of 1\u20135).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Photographs of facial asymmetries were correctly judged as asymmetrical over 90% of the time for 2 mm or more of asymmetry in eyelid closure, and 3 mm or more of asymmetry during smiling. Identification of eyebrow elevation asymmetry gradually rose from 23% correct to 97% correct across the range of 1 mm to 6 mm of asymmetry. Greater degrees of asymmetry were ranked as significantly more unnatural across all expressions (3 tests; <jats:italic>X<\/jats:italic><jats:sup>2<\/jats:sup> (6, N\u2009=\u2009145)\u2009=\u2009405.52 to 656.27, all <jats:italic>P<\/jats:italic> &lt;0.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Thresholds for asymmetry detection vary across different zones of the face; once detected, asymmetry in eyelid position is perceived as more unnatural than asymmetries in either brow elevation or smile. These data will inform counseling of patients with segmental facial weakness and may provide more objective goals for facial reanimation procedures.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>4. <jats:italic>Laryngoscope<\/jats:italic>, 124:860\u2013865, 2014<\/jats:p><\/jats:sec>","DOI":"10.1002\/lary.24331","type":"journal-article","created":{"date-parts":[[2013,7,30]],"date-time":"2013-07-30T14:27:41Z","timestamp":1375194461000},"page":"860-865","source":"Crossref","is-referenced-by-count":59,"title":["Determining the threshold for asymmetry detection in facial expressions"],"prefix":"10.1002","volume":"124","author":[{"given":"Marc H.","family":"Hohman","sequence":"first","affiliation":[{"name":"Department of Otology and Laryngology Harvard Medical School Boston Massachusetts U.S.A"},{"name":"Facial Nerve Center Massachusetts Eye and Ear Infirmary Boston Massachusetts U.S.A"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sang W.","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Otology and Laryngology Harvard Medical School Boston Massachusetts U.S.A"},{"name":"Facial Nerve Center Massachusetts Eye and Ear Infirmary Boston Massachusetts U.S.A"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth S.","family":"Heller","sequence":"additional","affiliation":[{"name":"Massachusetts General Hospital Institute of Health Professions Boston Massachusetts U.S.A"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice","family":"Frigerio","sequence":"additional","affiliation":[{"name":"Department of Otology and Laryngology Harvard Medical School Boston Massachusetts U.S.A"},{"name":"Facial Nerve Center Massachusetts Eye and Ear Infirmary Boston Massachusetts U.S.A"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James T.","family":"Heaton","sequence":"additional","affiliation":[{"name":"Massachusetts General Hospital Institute of Health Professions Boston Massachusetts U.S.A"},{"name":"Department of Surgery Massachusetts General Hospital Boston Massachusetts U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tessa A.","family":"Hadlock","sequence":"additional","affiliation":[{"name":"Department of Otology and Laryngology Harvard Medical School Boston Massachusetts U.S.A"},{"name":"Facial Nerve Center Massachusetts Eye and Ear Infirmary Boston Massachusetts U.S.A"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2013,10,2]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006527-200410000-00003"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/00129492-200411000-00026"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/archfacial.2010.101"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.21764"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.22481"},{"key":"e_1_2_6_7_1","article-title":"Detection and perceptual impact of side\u2010to\u2010side facial movement asymmetry","author":"Kim SW","journal-title":"JAMA Facial Plast Surg"},{"key":"e_1_2_6_8_1","first-page":"147","volume-title":"Facial Surgery: Plastic and Reconstructive","author":"Gliklich RE","year":"1997"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.3758\/BF03208842"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1037\/0735-7036.108.3.233"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0028-3932(96)00065-6"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/0028-3932(94)00135-C"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0b013e3181df6ff3"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1177\/0194599811427255"}],"container-title":["The Laryngoscope"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Flary.24331","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/lary.24331","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,4]],"date-time":"2023-10-04T00:37:01Z","timestamp":1696379821000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/lary.24331"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2013,10,2]]},"references-count":13,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2014,4]]}},"alternative-id":["10.1002\/lary.24331"],"URL":"https:\/\/doi.org\/10.1002\/lary.24331","archive":["Portico"],"relation":{},"ISSN":["0023-852X","1531-4995"],"issn-type":[{"value":"0023-852X","type":"print"},{"value":"1531-4995","type":"electronic"}],"subject":[],"published":{"date-parts":[[2013,10,2]]}}}