ObjectivesThis study aimed to investigate the impact of head circumference on the accuracy of three-dimensional (3D) facial scans, focusing on trueness and precision across three mannequin heads of different sizes. Material and methodsThree 3D-printed mannequin heads with circumferences of 30, 50, and 65 cm were used. Ten facial landmarks were identified to measure seven interlandmark distances and two angles. Direct anthropometric measurement, serving as the reference value, was taken using a digital vernier calliper for linear distance, and angle was calculated using the law of cosines. Each head was scanned six times using two systems: a dual-structured light facial scanner (iTom) and a stereophotogrammetry system (3dMD). Digital measurements were analysed using Meshlab and Blender for distances and angles, respectively. Trueness values were determined by comparing measurements to reference measurements, while precision values were derived from the variability among the six scans. Statistical analysis was performed using the Kruskal–Wallis test due to nonhomogeneous variances, followed by Bonferroni correction for pairwise group comparisons. ResultsFor each scanning system, overall deviations in trueness and precision significantly increased with head circumference. Five of the seven distances and one angle showed significant compromises in trueness with larger head circumferences. Most measurements exhibited significant precision decreasing due to head circumference changes, except for N-Pn and Pn-Sn. Additionally, 3dMD displayed higher overall trueness compared to iTom, with five out of seven linear measurements and one angular measurement showing better results. ConclusionHead circumference significantly affects both trueness and precision of 3D facial scans for both technologies, suggesting that facial imaging should be used with caution for larger faces. Selecting an appropriate scanning system, such as 3dMD, can help mitigate the negative effects of scanning larger objects.