Nothing in nature is perfectly symmetric. All faces have some degree of asymmetry. However, more pronounced asymmetry may become bothersome and, in severe cases, are indicative of an underlying syndrome. Facial asymmetry can result from congenital problems, trauma, or a prior surgery or treatment.
In some cases, asymmetry may affect not only the form, but also the function of your eyes, nose, and mouth. Often, the lower jaw is uneven with the rest of the face, which may be corrected with orthognathic surgery. Other problems may include cheek retrusion (backward displacement), eye displacement, eyebrow lowering, forehead and brow bone protrusion, or retrusions and nasal deviations.
Your plastic surgeon, in coordination with any other specialists needed, will examine your facial structure and carefully create a plan to reposition bones to create a more symmetrical appearance. Our surgeons are experts in both aesthetic and reconstructive surgery and frequently employ techniques from both areas to achieve optimal results for facial asymmetry.
Planning and recovery
What to expect
Your doctor will make a thorough examination of your face using photos and imaging for diagnosis and treatment planning. Together, you’ll discuss in detail the recommendations and suggested treatment process. Depending on the issues to be corrected, multiple surgeries may be needed to achieve the desired results. Correction may require moving bone (osteotomy), adding bone (bone graft), adding a facial implant (alloplastic implant), reducing bone, adding soft tissue, or reducing soft tissue (through liposuction) to create a more symmetrical result. Fat grafting may also be helpful in improving soft tissue results.
Because of the myriad of tools that can be used, it’s important that you see a surgeon who is skilled with all techniques so that your treatment isn’t limited by a particular set of tools or approaches. In many cases, your surgeon will work with other specialists to carefully plan treatment both before and after surgery.
On the day of the procedure, you will receive anesthesia through an IV. The specific approach will depend on the procedure(s) being performed and may include changes in the forehead, eyebrows/brow bones, ears, eyelids, nose, cheeks, lips, chin, jawline, or neck.
Recovering after facial asymmetry surgery
Depending on how extensive the surgery is, you may return home the same day or spend a night or two in the hospital. You’ll return home with instructions and medications from your doctor. Swelling and bruising after surgery is normal. Swelling and pain will typically peak a few days after surgery, and then resolve within a few weeks.
Frequently asked questions
Am I a candidate for facial asymmetry surgery?
You may be a good candidate if:
- You’re physically healthy
- Your expectations are realistic
- You understand the risks that come along with surgery
- You’re unhappy with your face’s proportion or balance
- You experience functional impairments because of your face’s asymmetry
How much does facial asymmetry surgery cost?
Because each facial asymmetry surgery is highly unique to the individual, costs vary based on your specific needs. Insurance coverage may be available when your insurance carrier determines the procedures to be medically necessary to address deformities or functional problems.
When you come in for your consultation visit, we will be better able to discuss fees in detail with you. Our staff will also review the financing options available and help with insurance approval questions.
Are there different degrees of facial asymmetry?
Yes, asymmetry may be mild, moderate, or severe:
- In the mildest cases, dermal fillers alone or combined with fat grafting, may be a reasonable strategy for correcting asymmetry. However, in almost all cases, both the skeletal and soft tissues are contributing to the problem, which ultimately requires skeletal solutions. Attempting to correct facial asymmetry with soft tissue fillers alone may improve volumetric symmetry, but will likely result in a soft, doughy appearance.
- When the asymmetry isn’t severe enough to warrant moving the jaw bones, facial implants may be used. These can be placed in the cheeks, the lower jaw, or the midface. In many cases, the underdeveloped side is a combined skeletal and soft tissue deficiency, and a mild disparity in size with normal contours and texture may be preferable over a “symmetric” skeleton with an angular appearance on one side and a soft tapered appearance on the other. In cases of moderate to severe lower jaw asymmetry, for example, it’s recommended to reduce the size of the implant and use fat grafting over the implant to create the optimal contour and texture of the face. For people with moderate cheek asymmetry, an implant is usually used to recreate symmetry and fat used to reestablish soft tissue volume, thereby enhancing a natural appearance. Fat grafting can be performed at the initial surgery and repeated as necessary in the office under local anesthesia. To minimize surface irregularities, it is important to layer the fat deep to lift the overlying normal tissue rather than add the fat superficially.
- For severe asymmetry, jaw movement surgery (orthognathic surgery), jaw reduction, or augmentation surgery or chin surgery may be needed. Moving the upper and lower jaws into a symmetric position may be the most powerful tool to correct severe facial asymmetry, but for those who don’t want to undergo surgery of this magnitude, camouflage procedures using facial implants and fat grafting can create an improvement in facial symmetry through less invasive techniques. When large asymmetric movements of bone occur, the soft tissue response is unpredictable and doesn’t necessarily translate into soft tissue symmetry despite underlying skeletal symmetry. Fat grafting may be considered at the time of surgery in areas where soft tissue asymmetry is anticipated or as part of a revision procedure after swelling resides and soft tissue asymmetries become evident. Asymmetry of the chin has a profound impact on the symmetry of the face. In many cases, severe asymmetries can be significantly improved by centering the chin’s position and feathering the edges with fat grafting.
What are the risks of facial asymmetry surgery?
As with any surgery, facial surgery does pose some risks. These risks include:
- Anesthesia complications
- Damage to bone, eyes, ears, nose, teeth, or gums
- Nerve damage
- Additional surgery to address complications or unanticipated anomalies in healing
Is facial asymmetry covered by insurance?
Insurance coverage is often available when your insurance carrier determines the procedures to be medically necessary to address deformities or functional problems. It is always best to discuss coverage with your insurance carrier and the steps necessary for approval. Our office will assist you with the paperwork needed for pre-approval.
Do I need a referral to your office?
If you’re exploring options for insurance coverage, you may need to request a referral from your primary care doctor, depending on your health insurance plan. Check with your carrier to see if medical coverage is an option for you and, if so, whether a referral is required.
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Craniofacial Plastic Surgery
Stephen Bradley Baker, MD,DDS
Pediatric Plastic Surgery, Craniofacial Plastic Surgery & Plastic Surgery
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3800 Reservoir Rd. NW Washington, DC, 20007
110 Irving St. NW Washington, DC 20010