Ample data exists about the high precision of three-dimensional (3D) scanning devices and their data acquisition of the facial surface. However, a question remains regarding which facial landmarks are reliable if identified in 3D images taken under clinical circumstances. Sources of error to be addressed could be technical, user dependent, or patient respectively anatomy related. Based on clinical 3D photos taken with the 3dMDface system, the intra observer repeatability of 27 facial landmarks in six cleft lip (CL) infants and one non-CL infant was evaluated based on a total of over 1,100 measurements. Data acquisition was sometimes challenging but successful in all patients. The mean error was 0.86？mm, with a range of 0.39？mm (Exocanthion) to 2.21？mm (soft gonion). Typically, landmarks provided a small mean error but still showed quite a high variance in measurements, for example, exocanthion from 0.04？mm to 0.93？mm. Vice versa, relatively imprecise landmarks still provide accurate data regarding specific spatial planes. One must be aware of the fact that the degree of precision is dependent on landmarks and spatial planes in question. In clinical investigations, the degree of reliability for landmarks evaluated should be taken into account. Additional reliability can be achieved via multiple measuring. 1. Introduction Objective evaluation of the face is challenging. Meaningful assessment by basic measurements is hindered by the complex three-dimensional (3D) anatomy of the face because of its specific but not perfect symmetry. Anthropometry, the science of measuring the characteristics of the body [1], has dealt with this problem for many decades. Regarding the underlying bony structures, 3D evaluations based on computed tomography data have become more and more routine [2, 3]. However, no standard has developed for three-dimensional imaging of the soft tissues so far. The state-of-the-art method for facial soft tissue evaluation and documentation is direct measurement and two-dimensional (2D) photography [4–6]. Both have immanent downsides: Direct measurements are examiner-dependent and retrospective surveys are impossible. Both of those qualities limit the use of the application in clinical follow-up studies. Two-dimensional photography can be calibrated for true-to-scale measurements, but only distances between points in the exact same plane as the photo can be measured accurately. However, there are few flat planes on the human face. Volumetric measurements or image fusion techniques are not possible when utilizing 2D photos [1, 7–12]. Modern
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