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Anomaly

Wide Eyes and Creepy Smile

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Visual-class anomaly: patient at the window shows abnormally large, wide-open eyes paired with a disturbing fixed smile (Fandom variant 1 of Unnatural Facial Appearance).

Overview

Wide Eyes and Creepy Smile is the AH-side name for Fandom's variant 1 of the Unnatural Facial Appearance anomaly. The Fandom infobox documents two variants of this category: variant 1 has big eyes, black pupils, prominent eyebags, and a drawn-on smile (the version this entry covers); variant 2 has small wide eyes with realistic teeth. Both variants are detectable via the same three channels (Visual, Photo, Camera) and both carry the guaranteed low-pitched distorted voice that all appearance-class anomalies share.

The defining mechanical behaviour is constant staring — the patient locks gaze on the player and doesn't break it during dialogue. Combined with the eye scaling and the static drawn-on smile, the overall effect is uncanny rather than monstrous. The Fandom page also notes 'loss of real face' as a mechanic — the underlying patient face is replaced rather than overlaid, which means the variant render is what you see at all times.

How to Spot It

Visual confirmation at the admission window is the fastest path. The eye scaling alone is suspicious; the drawn-on smile alone is suspicious; the two together are a confirmed reject. There is no normal patient model that pairs both cues, so simultaneity is the high-confidence signal.

Photo Camera and CCTV both surface the same render — useful as backup but not necessary for confirmation. Voice tell: guaranteed low-pitched and distorted during dialogue, audible from the lobby.

The constant-staring behaviour is the mechanical tell that confirms the anomaly even if the visual cues are subtle in a particular render. Watch for unbroken eye contact during a full dialogue line — normal patients break gaze; this anomaly doesn't.

Video Guide

Detection demo video coming soon.

Mechanics & Behavior

  • Detection methods: Visual, Photo, and Camera
  • Variant 1: Big eyes, black pupils, prominent eyebags, drawn-on smile (this entry)
  • Variant 2: Small wide eyes, black pupils, realistic teeth (covered separately if needed)
  • Constant staring — locked gaze on player throughout dialogue
  • Loss of real face — underlying face replaced rather than overlaid
  • Voice: guaranteed low-pitched and distorted

Easy vs Hard Calls

Pros

  • ✓ Eyes obviously larger than other queued patients
  • ✓ Drawn-on smile is fixed and doesn't move with dialogue
  • ✓ Voice immediately distorted at first dialogue line

Cons

  • ✗ Eye scaling can be confused with normal patient variation if you're not comparing against the rest of the queue
  • ✗ The drawn-on smile reads as 'cartoonish' rather than 'monstrous' — easy to dismiss as flavour
  • ✗ Variant 2 (small wide eyes + realistic teeth) is a different render — don't expect identical visual cues every encounter

At a Glance

At a Glance

Detection method
Visual
Sanity damage
—
First appears
Shift 1
Risk level
high

How to Handle This Anomaly

Reject at the window the moment both cues are confirmed simultaneously. Single-cue detection (just the eyes, just the smile) is still high-probability anomaly but worth a second-look via Photo Camera if you're uncertain on a particular render.

Do not engage with the constant-staring behaviour — there's no benefit to making eye contact with a confirmed or suspected anomaly. The stare is mechanical, not interactive.

If admitted, transforms into a Skinwalker on the hospital floor. See /wiki/enemies/skinwalker for combat counter (Gun or Taser, two shots).

Variant identification: if the patient has small wide eyes and realistic teeth instead of the big-eye/drawn-on-smile combination, you're looking at variant 2 of the same anomaly category. Same detection logic, same admit consequence — the variant only changes the visual rendering, not the workflow.

Patch History

No documented balance changes to detection cues or mechanics. Stable across all updates through 2026-06-28. The two-variant structure has been consistent since launch.

Frequently Asked Questions

Is Wide Eyes and Creepy Smile the same as Unnatural Facial Appearance?
Yes — this entry covers Fandom's variant 1 (big eyes, black pupils, eyebags, drawn-on smile). Variant 2 has small wide eyes with realistic teeth — same anomaly category, different render.
What's the difference between variant 1 and variant 2?
Variant 1: big eyes, black pupils, prominent eyebags, drawn-on smile. Variant 2: small wide eyes, black pupils, realistic teeth. Both are detected the same way and have the same admit consequence.
Does the patient's gaze follow me?
Yes — constant staring is the mechanical tell. The patient locks gaze on the player and doesn't break eye contact during dialogue. Confirmation backup if visual cues are ambiguous.
Can I detect this via Photo Camera only?
Yes — triple-channel detection (Visual, Photo, Camera) per the Fandom infobox. The Photo Camera surfaces the same render as the live view.
What does 'loss of real face' mean?
The underlying patient face is replaced rather than overlaid. The variant render is what you see at all times — you can't 'peek through' to a normal face underneath. The mask is the face.
What's the voice cue?
Guaranteed low-pitched and distorted during dialogue. Audible from the lobby and serves as a backup tell if you weren't watching the window when the patient queued.
What happens if I admit this anomaly?
Transforms into a Skinwalker on the hospital floor. From there it needs a Gun or Taser (two shots) to neutralise — see /wiki/enemies/skinwalker.
Is this related to the Three Eyes anomaly?
Both are appearance-class with visual-channel detection and constant-staring or head-tracking behaviour. Three Eyes is anatomically obvious (three sockets); Wide Eyes and Creepy Smile is uncanny rather than impossible. Distinct anomalies that share a detection category.

The paired-cue test

A solo cue doesn't rule this one out. Some normal patient models have slightly larger eyes; others have a smile that looks frozen for a beat. What confirms Wide Eyes and Creepy Smile is the combination — both anatomical exaggeration and the locked-in grin in the same patient. If you only see one of the two, hold the window view another second before deciding.

Why this anomaly is the "rushing" trap

Visual anomalies that need a deliberate read are the ones most often missed when the queue is moving fast. Both of this one's cues are visible without tools — no Photo Camera, no CCTV switch — so it should be the easiest class to catch. In practice, players miss it during ambulance waves because their attention is on the room board, not the patient face. If you're triaging, slow down on the visual layer specifically.

Mistakes that cost the run

  • Confirming on one cue and stamping. Either feature alone is ambiguous; treat the combination as the diagnostic.
  • Not pausing during ambulance. This anomaly fires at any shift, including the Shift 4 ambulance wave when rushing is tempting.
  • Trying to verify with the Photo Camera. Both cues already show at the window. Photo wastes a slot turn.

What happens if you stamp it through

Like every admitted anomaly, this patient transforms into a Skinwalker on the hospital floor. The combat phase — Gun, Taser, or Fire Extinguisher counters — is documented at /wiki/enemies/skinwalker. If you're going to deal with the consequence, also read the Mismatched Eyes and Sharp Teeth entry — it's the most visually-similar tell to confirm you're not conflating the two next time.

Sources: Techwiser anomalies guide, Destructoid walkthrough.