Objective: To determine whether a smiling profile photo should be taken on each patient on initial exam. Materials and Methods: 27 patient photographs were taken from the orthodontics clinic at the University of Maryland to be evaluated. A smiling and repose profile photograph for each patient was reproduced 4 times to make 4 different randomizations. A book of visual analog scales was given to 59 randomly selected laypeople to rate each photo. Results: Ten of 14 patients who showed a significant difference between the smiling and repose profile photos had a lower smiling photo score. There is no difference based on rater, gender. Conclusions: The smiling profile photograph may be an important tool in performing a thorough orthodontic diagnosis and treatment plan. Laypeople can detect the differences in smiling and repose profiles of the same patient and patients should be made aware of their own discrepancy by the orthodontist.