Facial asymmetry: causes, treatments and when to correct it

Facial symmetry plays an important role in how we perceive the harmony of the face, but it is common for all of us to have some degree of imbalance. When facial asymmetry is very noticeable, it can affect self-esteem and cause aesthetic or functional concerns. In this Clínica EGOS article we review why it appears, when it is considered normal and what surgical and non-surgical treatments exist, depending on its cause.

Is it normal to have facial asymmetry?

Yes. We all have some degree of facial disharmony. A 2017 review in Aesthetic Surgery Journal (Wang and colleagues) points out that perfect symmetry is even unsettling and that a certain degree of asymmetry is considered normal. That same review established the difference at which people begin to notice it for each feature: about 2 millimetres in the resting position of the eyelid, 3 at the corner of the mouth, 3.5 at the eyebrow, 4 at the tip of the nose and 6 at the chin.

What matters is when asymmetry stops being a personal characteristic and becomes a problem. According to Cheong and Lo (2011), significant facial asymmetry causes functional and aesthetic problems, and when someone consults about it, the underlying cause should be investigated.

Why is my face asymmetrical? Causes of facial asymmetry

There are several reasons why a person may have facial disharmony. They can be congenital, present from birth, or acquired over time. Cheong and Lo group them into congenital disorders, acquired diseases, trauma and developmental deformities, and point out that in many cases of developmental asymmetry the cause is unclear.

Genetic factors

Heredity plays a key role in facial structure. Some people are born with differences in the development of the facial bones or muscles that can cause asymmetry.

Growth and development

During childhood and adolescence, uneven growth of the facial bones can produce a noticeable asymmetry. Habits such as thumb-sucking or always sleeping in a poor posture have also been linked to it.

Dental and bite problems

An incorrect bite (malocclusion) can affect the balance of the face. Situations such as a crossbite or a deviated jaw can make one side of the face develop more than the other. Cheong and Lo note that it is common to find dental malocclusion, a tilted occlusal plane and a deviated midline.

Trauma and injuries

A blow to the face, especially in childhood, can alter bone growth and cause asymmetry. Badly healed fractures can also contribute.

Facial palsy

Conditions such as Bell's palsy affect the facial nerves and cause a lack of movement on one side of the face, which creates asymmetry. The 2013 clinical guideline on Bell's palsy (Baugh and colleagues) describes it as a weakness or paralysis of the facial nerve of rapid onset and unknown cause, which usually resolves on its own but can prevent the eye from closing; for that reason, a change of this kind, if it is sudden, requires medical attention.

Ageing

The passage of time affects the elasticity of the skin, bone loss and the redistribution of fat, and that is why facial asymmetry can become more evident over the years.

Always chewing on one side

It is said that the habit of chewing only on one side of the mouth can develop uneven musculature and make one side look more prominent than the other.

How is facial asymmetry assessed?

Before considering any treatment, it is necessary to know where it comes from. According to Cheong and Lo, the assessment consists of a medical history, a physical examination and imaging tests, which help to measure the asymmetry objectively and to plan the treatment, and it looks at the soft tissue, dental and bone components. Srivastava and colleagues (2018) add that clinically significant asymmetry calls for a full examination together with imaging studies.

That is why the first step is always a consultation: the solution depends on whether the origin lies in the bone, the teeth, the muscles, the skin or the fat.

How can asymmetry in the face be corrected?

There are various alternatives, which depend on the cause and the severity. They can be surgical or non-surgical, and the most suitable decision is made with the specialist, after examining you. If the origin is muscular, the doctor assesses the options at the consultation.

Non-surgical treatments

If the asymmetry is mild or moderate, there are non-invasive options that can improve facial harmony.

Injectable fillers

Aesthetic medicine fillers can be used to balance the features, adding volume to disproportionate areas such as the cheekbones or the jaw. These are temporary treatments.

Orthodontics

When the asymmetry is caused by a poor bite, braces or clear aligners can help improve facial harmony. Cheong and Lo explain that, when the asymmetry is combined with dental occlusion problems, orthognathic surgery is used, which repositions the jaws and aims for a symmetrical midline, a harmonious profile and a correct bite.

Facial exercises

In cases of mild muscular asymmetry, exercises to strengthen the muscles are sometimes recommended, but it is worth knowing that the evidence is limited: a 2014 systematic review (Van Borsel and colleagues) of nine studies concluded that the available data are insufficient to know whether facial exercises work for facial rejuvenation, because none used a control group or random assignment. They are not a substitute for an assessment.

Surgical treatments

For more marked cases, surgery can be a solution, always chosen according to the cause. Cheong and Lo point out that, in addition to treating the cause, additional procedures may be needed to increase or reduce the volume of the skeleton and soft tissues on both sides and achieve better symmetry.

Facelift

The facelift aims for a more balanced appearance by removing excess skin and repositioning the facial tissues, and in doing so helps to improve symmetry. The ASPS (American Society of Plastic Surgeons) adds that, during a facelift, fat transfer or fillers may be suggested to restore lost volume. If you are looking for this surgery in Barcelona, there is the facelift in Barcelona page.

Blepharoplasty

Blepharoplasty is a cosmetic surgery that can correct asymmetry of the eyelids, removing excess skin and fat to improve facial harmony. To find out more, read our article on upper blepharoplasty.

Mentoplasty (chin surgery)

Mentoplasty (chin surgery) makes it possible to change the shape and size of the chin to improve facial symmetry, either with implants or with reduction surgery. According to the ASPS, chin surgery can be done with an implant that gives projection or by reducing the bone, and the jaws can be modified to improve the bite.

Common situations of facial asymmetry and what is considered in each

These are not patient cases, but common situations, so that you can see how the approach changes depending on the origin.

A slight difference in the smile, the eyebrow or the eyes

This is the most common, and most of the time it does not require treatment. If it bothers you, the consultation is there to decide whether simply observing is enough or whether an aesthetic medicine treatment could help.

A jaw or a bite that do not fit together

When the origin lies in the teeth or the jaw, the route is orthodontics or, in the most complex cases, orthognathic surgery. The specialist here is the maxillofacial surgeon; at EGOS we can point you towards one.

A change that shows up over the years

If the asymmetry becomes more visible with age because of volume loss or uneven sagging of the tissues, fillers or surgery are considered, depending on the degree.

A deviated or under-projected chin

Mentoplasty (chin surgery) is considered when the problem lies in the chin and its proportion to the rest of the face, and it can be combined with other procedures.

After trauma or palsy

Here the treatment is set by the medical team following the injury; the aesthetic side is considered afterwards, and sometimes with several specialists at once. Kobus and Kobus-Zaleśna (2017) point out that some degree of asymmetry, congenital or acquired, is normal and universal, and describe combined, multidisciplinary treatments for extensive post-traumatic asymmetries.

When should you consult a specialist?

If you notice a sudden change in the face, if you have lost the ability to move one side of the face or to close an eye, or if the asymmetry comes with pain, see a doctor as soon as possible. If it is a lifelong characteristic that worries you, ask for an assessment with a plastic surgeon. When it is worth intervening is an individual decision: Wang and colleagues (2017) observed that the desire for surgery grows exponentially, not linearly, as the asymmetry exceeds a certain threshold. If you are comparing clinics, our guide on how to choose a plastic surgeon will be useful to you.

Conclusion on facial irregularity

Facial asymmetry is a feature of every face, but when it becomes pronounced it can cause aesthetic and functional concerns. There are options to correct it, from non-surgical treatments to advanced surgeries, and the choice depends on the cause. If the asymmetry of your face worries you, consult a specialist to find the most suitable solution for you.

Informative text about facial asymmetry. It is not a diagnosis and does not replace the assessment of a healthcare professional, and the result of a treatment varies from one person to another. Clínica EGOS.