Assessing outcomes in facial reanimation: evaluation and validation of the SMILE system for measuring lip excursion during smiling.

T here is no current consensus for objectively evaluating postoperative smiling outcome. Several objective measurement systems have been proposed, but, owing to their complexity, cumbersome nature, or cost, no single system has been adopted. With such variation in the reporting of results, it is difficult to make comparisons and draw conclusions about the outcome of different surgical techniques. We propose a simple facial analysis system, the scaled measurement of improvement in lip excursion (SMILE), that obviates the need for expensive equipment, facial marking, or prolonged patient cooperation. The system uses the iris diameter (corneal white-to-white diameter) as a scale reference for all facial dimensions on the same photograph. Rüfer et al measured the corneal white-to-white diameter in 390 healthy subjects aged 10 to 80 years with the Orbscan II system (Bausch & Lomb, Rochester, New York). They found the mean(SD)cornealdiameterwas11.77(0.42)mm.Withsuch small variation inhuman irisdiameter, thisbuilt-in scale— inthesameplaneas theoralcommissure—allows“real-life” millimetricmeasurementsofhorizontal toverticalcommissureexcursion tobeextrapolated fromfrontalphotographs using readily available photoediting software.