Context-dependent aesthetic perception after facial local flap reconstruction for cutaneous malignancies: a multi-observer study integrating patient-reported outcomes and public perspective

Background Local flaps are fundamental for reconstruction of facial defects after cutaneous tumor resection, yet perceived aesthetic success may differ among surgeons, patients, and the general public. Objectives To investigate context-dependent aesthetic perception across facial regions and evaluator groups and its relationship with patient-reported FACE-Q outcomes. Methods Twenty-three patients undergoing local flap reconstruction after facial tumor resection were evaluated using preoperative and 12-month postoperative photographs. Overall, 203 evaluators—plastic surgeons, non-plastic surgeons, non-surgical physicians, and the general public—rated outcomes on a five-point scale, first using postoperative images alone and subsequently after viewing corresponding preoperative photographs. FACE-Q Face Overall, Natural Appearance, and Psychological Function scales were assessed preoperatively and postoperatively. Results Preoperative context resulted in significantly more critical ratings across perioral, periocular, and malar regions (all p <0.001). Perceptual shifts differed among evaluator groups in perioral ( p =0.007) and periocular ( p =0.015) regions, with plastic surgeons showing smaller shifts. FACE-Q Face Overall and Natural Appearance scores improved significantly postoperatively. A study-specific summary score derived from the three selected FACE-Q scales was significantly associated with general-public ratings ( ρ = −0.56, p = 0.008). Conclusions Aesthetic assessment after facial local flap reconstruction is context-dependent. Integrating FACE-Q patient-reported outcomes with public perception may provide a more patient-centered assessment of reconstructive success.