Reflecting on Your Reflection – Examining the Effect of a Non-Reversing Mirror on the Self-Perception of Individuals Interested in Aesthetic Facial Procedures

Goals/Purpose: Patient photographs are a valuable planning and communication tool in plastic surgery. However, photographic images can clash markedly with patients’ self-perception. These static, 2-dimensional images lack dynamism, capturing only a single moment, expression, light, and angle. More importantly, they are the reverse of the more familiar image an individual sees in a mirror. Consequently, facial asymmetries appear “flipped” in photographs, making them appear exaggerated to the individual. A non-reversing mirror (NRM) allows patients to see their dynamic, non-reversed image and familiarize themselves with how they appear in photographs and to others. Thus, the aim of this study was to explore the effect that a NRM has on facial self-perception, and whether or not it changes an individual’s goals when considering facial cosmetic procedures.

Methods/Technique: Individuals interested in obtaining facial aesthetic surgery or non-invasive cosmetic procedures (n=30) were asked to inspect their reflections in both a NRM and a standard mirror for thirty seconds each. The order in which these two mirrors were used was randomly assigned using a random number generator. Following each thirty second period, subjects completed sections of the FACE-Q™. Following the completion of these questionnaires twice, subjects were asked a brief series of open-ended, qualitative questions comparing the two mirrors. Descriptive data such as age, gender, race, and history of prior facial aesthetic procedures were collected. Wilcoxon signed-rank, Mann Whitney U, and Pearson’s Chi-squared tests were performed for analysis.

Results/Complications: Median subject age was 31.5 years; 60% were female. Participants scored significantly worse on the FACE-Q™ Age Appraisal and Appearance-Related Psychosocial Distress when using the NRM vs. standard mirror (p=0.007 and 0.001, respectively). However, there was no significant difference in Age Visual Analogue Score. The order in which the mirrors were used did not have a significant effect on any of the questionnaire scores (p>0.05). Similarly, there was no significant difference in scores between subjects with a history of aesthetic facial procedures and those without (p>0.05). Chi-squared analysis initially demonstrated that females were significantly more likely to notice a difference in the NRM (p=0.046); subjectively, female subjects exhibited much stronger emotional reactions to their reflections. However, upon post-hoc testing, this difference was no longer statistically significant. In response to the supplementary questions, 83.3% of participants reported a qualitative difference in their appearance when looking into the NRM. When asked to elaborate on what they noticed, asymmetry or exaggeration of a perceived flaw was the most common complaint. Most subjects reported that their faces seemed less symmetric and less balanced (73% and 53%, respectively) in the NRM. Thirty percent endorsed that looking in the NRM had changed their facial aesthetic surgical goals.

Conclusion: A NRM can serve as a bridge between the familiarity of the patient’s reversed reflection and their less-familiar, non-reversed photographs. It may serve as a useful physician-patient communication tool when discussing goals and expectations for facial aesthetic procedures.