Abstract
INTRODUCTION: Although melasma leads to emotional distress and quality-of-life reduction, indigenous cultures practice female facial tattooing. Facial cues influence personality trait inferences and attractiveness ratings. Skin lesions have been shown to alter gaze patterns, emotion perception, and social evaluations. AIM: This study aimed to evaluate melasma's impact on visual attention, perceived attractiveness, and social evaluations, considering distinct anatomical areas. Additionally, we sought to compare perceptions of traditional facial tattoos due to their purposeful placement. MATERIAL AND METHODS: Gaze fixation patterns were examined via eye-tracking, and image-based personality questionnaires were completed for psychological trait assessment. Visual stimuli showcased anatomic melasma variants and tattoo patterns. RESULTS: Traditional tattoos often follow midline patterns, sparing the upper lip. Both melasma and tattoos significantly affected visual attention (p < 0.001), with chin and upper lip melasma garnering increased attention. Upper lip melasma decreased gaze to the ocular area (p ≤ 0.002). while increasing perioral fixations (p < 0.001) compared to healthy faces. Upper lip tattoos conveyed increased perceived aggressiveness (p = 0.004). Ratings for attractiveness and personality traits were lower for centrofacial melasma than other variants, with no significant difference between centrofacial and isolated upper lip melasma. CONCLUSIONS: The global avoidance of upper lip pigmentation underscores its perceptual burden. Upper lip pigmentation directs gaze towards anger-signalling regions, increasing perceived aggression and reducing attractiveness. Centrofacial melasma's impact parallels an isolated upper lip pattern, underscoring the disproportionate role of upper lip pigmentation. These findings warrant considering upper lip melasma's significant influence when evaluating quality of life and establishing treatment goals.