Archives of Craniofacial Surgery (대한두개안면성형외과학회지)

Korean Association for Cranio Maxillo Facial Surgery (대한두개안면성형외과학회)
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Impact of orthognathic surgery on emotional expression and smile aesthetics in Chinese patients as measured by FaceReader: a before-and-after study

  • Thanapoom Boonipat (Department of Plastic and Reconstructive Surgery, Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University) ;
  • Jason Lin (Division of Plastic and Reconstructive Surgery, Department of Surgery, Saint Louis University) ;
  • Sai Cherukuri (Division of Plastic and Reconstructive Surgery, Department of Surgery, Mayo Clinic) ;
  • Zhi Yang Ng (Department of Plastic and Reconstructive Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust) ;
  • Eugene Yu-Jen Chen (Department of Plastic and Reconstructive Surgery, Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University) ;
  • Chuan-Fong Yao (Department of Plastic and Reconstructive Surgery, Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University)
  • Received : 2025.02.06
  • Accepted : 2025.06.20
  • Published : 2025.06.20
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Abstract

Background: The attractiveness of a person's smile is influenced by several factors, including gingival display, incisor show, and facial asymmetries. Malocclusion has long been recognized as having a significant negative impact on smile aesthetics. Addressing dentofacial deformities is a major treatment goal in orthodontic and orthognathic interventions, aiming to improve both functional and aesthetic outcomes. We sought to quantify and assess the impact of orthognathic surgery on a patient's expression of happiness within their smile, thereby addressing the current research gap in this highly subjective field. Methods: We utilized FaceReader, a commercially available and previously validated artificial intelligence (AI) system, to analyze preoperative and postoperative facial photographs of 216 Chinese patients who underwent orthognathic surgery between January 1, 2021, and December 31, 2022. The AI software measures seven cardinal emotions and associated facial action units, providing an objective evaluation of emotional outcomes. Results: Our findings indicated a significant postoperative increase in patients' expression of "happiness" while smiling, accompanied by a concurrent decrease in their estimated age. Patients with insufficient incisor show and open bite exhibited notable improvements in emotional expression, while those with a gummy smile showed no significant change. Additionally, stratification based on malocclusion classification (class I, II, III) revealed consistent improvements in emotional outcome scores among class II and III patients. Conclusion: Our findings underscore the potential of AI in providing objective insights into emotional changes following orthognathic surgery.

Keywords

Acknowledgement

We would like to thank the Department of Plastic and Reconstructive Surgery and the Craniofacial Center, Chang Gung Memorial Hospital, Taiwan for the administrative support for this work.

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