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Face-making: task-specific facial tensions and grimacing in musicians
  1. Andrew John Lees1,
  2. Michael Swash2,3
  1. 1 Reta Lila Weston Institute, Institute of Neurology, London, UK
  2. 2 Barts and The London School of Medicine and Dentistry, London, UK
  3. 3 Institute of Neuroscience, University of Lisbon Medical Faculty, Lisboa, Portugal
  1. Correspondence to Professor Michael Swash, Barts and The London School of Medicine and Dentistry, London E1 1BB, UK; mswash{at}

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I have been told that my facial expressions while playing are quite pronounced, and numerous audience members have asked me what in the world I am saying to myself as I play. In the act of practicing or performing, I am totally unconscious of any of this: I had to be asked and told, and to watch myself on video, to realise it was happening. It really does look as if I'm having a lively conversation with myself. Curtis Lindsay, pianist: blog at 11 June 2015

At a piano recital in a London concert hall, MS, seated on the right side of the auditorium, fairly far forward, was able to view the face and upper body of the pianist across the top of the Steinway concert grand piano. The performer, as usual, was seated right side-on to the audience. The performance, of a difficult programme that included works from the 18th and 20th centuries, was exceptional, technically near-perfect, emotionally expressive, with brilliance in tonality and colour. However, it was marred by the pianist’s florid, distracting facial movements, evident throughout the performance, even during a closing encore. Here, we consider the nosology of these performance-associated extraneous facial movements.

The facial mannerisms: ‘face-making’

During the performance the pianist displayed brief pursing movements of the lips, intermittent furrowing of the brow, forceful lateral and twisting movements of mouth and face, snarling expressions, a minor degree of tongue protrusion, darting eye movements to both sides, head retraction, elevation of the shoulders, forceful intakes of breath and, less frequently, a maintained posture of leaning backward away from the keyboard. The pianist’s legs seemed unaffected. There were no associated vocalisations. The facial movements appeared during every piece of music, commencing at the onset of each piece, but not evident before or immediately after the performance. During the performer’s walk …

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  • Contributors MS made the observation and both AJL and MS wrote the manuscript.

  • Funding Neither AJL nor MS received funding in preparing this manuscript.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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