Treatment for Facial Asymmetry

Facial asymmetry is defined as the condition where one half of the face is different to the other half. Minor asymmetries are very common and may be the small irregularities that define a face, provide individuality and make it interesting. However, major contour discrepancies are instantly recognisable and often perceived as affecting the aesthetic appearance. There are several ways to treat facial asymmetry, including: fat transfer, facelift procedures, soft-tissue adjustment, lipo-dermal grafts, customised implants, correction of the craniofacial architecture or modification of nerve and muscle function. The aim of treatment is to improve the balance between the two facial halves, providing a more symmetric and harmonious appearance.

Facial asymmetry exists in many grades and variations. Some are immediately obvious, while others are detectable only on close inspection. In general, a structural deviation must be greater than or equal to 4 mm, in order to render it visible. When the degree of asymmetry is less, the condition is usually imperceptible. The contour irregularities may be related to the facial bones or the many layers of soft-tissue. Some asymmetries are visible at all times ('structural asymmetry'), while others are evident only when the facial muscles move ('functional asymmetry').

The causes of facial asymmetry can be classified into three categories: (1) Congenital, of genetic or prenatal origin; (2) Developmental, arising during growth and development; (3) Acquired, originating from trauma, disease or surgery. If the asymmetry is not observed at birth or infancy and there is no obvious history of facial trauma or disease causing the asymmetry, it may be difficult to uncover the aetiology. For this reason, it is often classified as 'idiopathic' (unknown) or as an 'asymmetry of development'.

Any contour deficiency, deformation or asymmetry (whether mild or severe) will become more evident with age, due to the reduced tissue elasticity, soft-tissue atrophy and gravitational changes. For this reason asymmetries, which were not considered problematic during early adulthood, may cause concern in later life.

At the Sorensen Clinic we provide a wide range of specialised treatments for structural and functional facial asymmetries in adults.

Structural asymmetry

A structural asymmetry affects facial shape or contours and will be evident when the face is in a neutral expression. Although all anatomical structures of the head can be involved, the majority of patient concerns relate to asymmetric features in the central face. In particular, around the eyes, nose and mouth; e.g. asymmetry of brow position, upper and lower eyelids, midface, cheek bones, cheek volume, perioral area, chin and jawline.

Clinical examination, including facial measurements and photography, will determine which anatomical structures are involved. In more complex cases of structural asymmetry, a three-dimensional CT scan (Cone Beam CT Scan), combined with three-dimensional photography (3D Laser Surface Scanning) is used in the diagnostic process. These imaging tools have the ability to detect even minute differences in bone and soft-tissue between the two sides.

Functional asymmetry

A functional asymmetry becomes apparent when facial muscles are activated. The condition is often caused by neurological events, in particular, disorders relating to the 7th cranial nerve (facial nerve), which controls the muscles and facial expressions. Dysfunction of the nerve is associated with hemifacial weakness or paralysis, causing the two sides of the face to move asymmetrically. Nerve related asymmetries are often noted in the mobile tissue around the mouth and eyes; e.g. distorted smile, incomplete eyelid closure and/or imbalanced brow movement.

Another frequent cause of asymmetric facial movement is the presence of scar-tissue between the moving structures of the face. Scar tissue can restrict muscle function and lead to distortion of facial contours during speech or animation. This condition may be difficult to distinguish from nerve dysfunction (as described above), but has the advantage that if correctly diagnosed and treated, can be rectified completely.

Facial mapping and slow-motion film of facial movement is performed during consultation. This clinical analysis will reveal the location, extent and type of facial asymmetry.

Asymmetric facial ageing

Individuals with facial asymmetry will experience differences between the two sides of the face with regards to facial ageing. The dominant (stronger or fuller) side of the face will age at a normal rate, while the weaker side will tend to age faster.

Asymmetric ageing is especially noticeable in individuals with severe facial asymmetry (e.g. facial palsy), however the same phenomenon will also occur in individuals with mild to moderate asymmetry, although the age-imbalance between the two sides will be more subtle.

Surgical treatment for facial asymmetry

With specialised surgery, a facial asymmetry can be significantly improved upon and in some cases fully corrected. Treatment is unlike any other type of aesthetic facial surgery. Firstly, it is aimed at addressing the underlying issue which caused the asymmetry. Secondly, the aim is to normalise the surrounding tissue which may have been influenced or displaced by the asymmetry and finally, to compensate for any symptoms of asymmetrical ageing. For this reason, treatment may include components of facial reconstructive surgery, aesthetic surgery and microsurgery, all performed within the same procedure.

Although many minor to moderate structural asymmetries can be corrected within one surgical procedure, it is usually beneficial to apply a staged approach when treating either functional or major structural asymmetries. For example, If the condition involves both the craniofacial skeleton and the overlying soft tissues, it is normal to start by correcting the deeper asymmetries first and then address the superficial soft-tissue at a later stage. The same principle is also applied when the condition requires restoration of nerve and muscle function. The functional corrections are adressed first, followed by adjustments to the facial soft tissue at a later stage (3-6 months). A staged approach will always ensure the highest level of precision and predictability in the final aesthetic outcome.

Due to the varied nature of asymmetries, the choice of operative technique requires in-depth analysis and discussion during consultation. Dr Sorensen will outline the best options for how improvements can be achieved.