What is facial asymmetry?
Facial asymmetry means that your face isn’t perfectly symmetrical—one side looks different from the other. For example, your eyes might be a different size, or your jawline might be uneven.
Most people have some degree of facial asymmetry, and this is completely normal. However, in some cases, the unevenness is more noticeable and may even affect your health or how your face functions.
Facial asymmetry can be treated by a variety of specialists, including oral and maxillofacial surgeons, facial plastic surgeons, otolaryngologists (ear, nose, and throat doctors), and orthodontists. At Penn Medicine, our head and neck reconstructive surgeons specialize in creating custom 3D implants for the face and skull to help improve symmetry and restore function.
Facial asymmetry symptoms
Facial asymmetry can change how you look and how your nose, mouth, or eyes work. Symptoms can include muscle weakness, numbness, facial pain, difficulty chewing or speaking, and drooling. Significant deformities can lead to other conditions like obstructive sleep apnea.
Symptoms can affect different parts of the face:
- Eyes: One eye may appear larger or more closed, and one eyebrow may sit higher.
- Nose: The nose may tilt to one side or look crooked.
- Cheeks: One cheek may appear fuller than the other.
- Jaw and chin: The jaw or chin may be misaligned or uneven.
- Ears: One ear may look larger or be positioned differently.
- Overall face: One side may show more signs of aging, such as sagging or wrinkles.
What causes an asymmetrical face?
Facial asymmetry can be caused by many different things. These causes can be things you were born with or things that happen later in life.
Genes play a big role in how our faces look. Most differences in face size and shape—such as the width and height of the nose and its prominence, lip fullness, and the distance between the eyes—are likely influenced by genetics. Genetic factors can also contribute to facial asymmetry, affecting how balanced or uneven our features appear.
Facial asymmetry can result from injuries that damage the bones, soft tissues, or muscles of the face, causing uneven features or lasting changes in appearance.
Facial asymmetry can happen when something goes wrong with the nerves in the face. These problems can start from birth (developmental disorders) or happen later in life. For example, Bell’s palsy, brain tumors, and stroke are conditions that can cause one side of your face to droop.
Myopathies are conditions that weaken muscles. When facial muscles are affected, it can lead to uneven expressions and an asymmetrical appearance. For example, facioscapulohumeral muscular dystrophy is a condition that can cause weakness in facial muscles. Temporomandibular joint (TMJ) disorders are a common musculoskeletal problem that can produce an uneven bite and asymmetrical facial expression.
Some congenital (present at birth) conditions and developmental disorders can lead to facial asymmetry, including:
- Cleft palate
- Hemifacial microsomia
- Skull base abnormalities
- Congenital muscular torticollis
- Unilateral coronal craniosynostosis
- Positional plagiocephaly
Dental issues like disease, tooth extractions, dentures, and orthodontic treatments can change the shape of the face and jaw. Some dental work may lead to noticeable asymmetry. For example, crooked or crowded teeth can shift the jaw’s position. Tooth extractions may alter how facial muscles look, and dentures or veneers can change facial contours. A misaligned bite can also impact jaw alignment.
Facial asymmetry typically increases as we age, especially in the bottom two-thirds of the face. This happens due to several changes in our facial skin, bones, and muscles:
- Sagging skin: Aging reduces skin elasticity, causing sagging that makes one side of the face look droopier.
- Losing plumpness: Fat beneath the skin diminishes, making unevenness more noticeable.
- Weaker bones: Thinning jawbones alter the face’s shape, reducing symmetry.
- Weaker muscles: Muscle weakness leads to drooping and a more uneven appearance.
Lifestyle choices like smoking, which can cause gum disease, weakens the bones supporting the teeth and may lead to a misaligned bite.
Everyday habits, like sleeping on one side or on your stomach, chewing mostly on one side, or resting your face on your hand, can lead to muscle imbalances and facial asymmetry. Poor posture can also affect the alignment of your neck and jaw, changing the balance of your facial features.
Diagnosing facial asymmetry
During a physical exam, your care provider will check your face—the soft tissues, teeth, and bones—for differences in proportions, such as an uneven face or uneven jawline. They may also use photos and imaging to get a clearer view of any asymmetry.
These imaging tests may include x-rays, 2D cephalometric radiographs, and 3D cone-beam CT scans.
How to fix an asymmetrical face
Mild unevenness can often be improved with fillers or fat grafting. If the asymmetry is due to the skeletal structure, facial asymmetry surgery can correct it by reshaping or repositioning the bones.
Setting the standard in facial asymmetry care
Penn Medicine offers one of the largest facilities and advanced research and treatment programs for a wide range of oral and maxillofacial conditions, including facial asymmetry. Our specialists are leaders in surgical and non-surgical treatments for conditions that contribute to facial asymmetry, including diseases, disorders, and injuries of the mouth, teeth, jaws, and face.
Our surgeons use advanced 3D technology to create custom-made facial implants that improve symmetry and restore the face after trauma. For people with facial asymmetry caused by TMJ, Penn Medicine’s Center for Temporomandibular Joint Disease is internationally recognized for its pioneering TMJ surgery techniques to address uneven jaw problems.