The Smile Series: Capturing High Quality Digital Images at All Stages of the Human Smile

INTRODUCTION  Several plastic surgical procedures of the mid and lower face that affect the perioral structures (eg. perioral injectables, facelift, and orthognathic surgery) may affect the  patient’s smile.   The  smile is a dynamic entity; if one wishes to document and study a change in smile as a result of treatment, ideally one would record the perioral appearance throughout this entire movement. A static image obtained with the patient “smiling” captures only one instant within this complicated process and may be at an undesired instant. Furthermore anatomic assessment of the patient’s smile is an essential component of preoperative planning of certain procedures; for example in clinically determining where the maxillary segment should be spatially positioned with LeFort 1 osteotomy, maxillary dental display is measured. A problem however has been how to dynamically capture a specific patient smiling such that the surgeon can later: 1.  reproduce the complete smile in animation and 2.  extract a high-definition photograph at any stage of the smile. While video techniques solve the former, they do not allow for extraction of individual images of acceptable quality for analysis and later publication. METHODS We have developed a protocol that utilizes a digital camera in which high quality still images are obtained throughout a patient’s complete smile. A Canon 50D camera is set to a continuous shooting speed of 6.3 frames per second, at which approximately 50 images are captured over the course of a complete smile (Figure 1).  Color balance is set to match the modeling lights so that images are color corrected. Images are imported into an inexpensive PC-based computer and Com-U-Pic Pro (Photodex) software enables viewing of the complete series as an animated smile. This will be demonstrated in the presentation. (Video clip)  RESULTS The Smile Series has become part of our protocol for evaluating every prospective orthognathic surgical patient. It has also been used for patients with various facial clefts, skeletal asymmetries where this analysis is clinically indicated and in patients who have had perioral aesthetic procedures of the soft tissues. This series of images has been obtained for over 200 patients. We regularly use these images for preoperative planning and have also extracted individual publication quality images (Figures 2, 3). CONCLUSIONS A protocol has been developed for capturing a series of high quality digital images throughout a patient’s complete smile. This approach can be replicated using commercially available digital photography equipment. At our center it has been invaluable in planning orthognathic procedures yet has potential value in any clinical situation where careful evaluation of perioral anatomy throughout all stages of the smile is desirable.