Facial asymmetry. Causes and treatment methods

Take a photo of yourself facing the camera. Cut it in half, then put the two right halves together into one face. Then do the same with the left ones.

There are no perfect proportions in nature. Nobody has a symmetrical body, and certainly not a symmetrical face.

When asymmetry stops being the norm

Day to day you do not see it. We look in the mirror, everything adds up, nobody counts millimetres.

The problem begins when the differences are really large. That is when they start to jar. To get in the way. To create insecurities. Sometimes other people's comments about a "crooked face" are added on top — and that hurts especially during adolescence.

The good news is that for aesthetic medicine an asymmetrical face is not a problem. It can be corrected quickly and with little invasiveness.

Where facial asymmetry comes from

There are several causes and not all of them have anything in common.

Major asymmetry is sometimes the result of mechanical trauma, malocclusion, facial nerve palsy or stroke. But sometimes that is simply what genetics looks like — and there is nothing more behind it.

It also happens that we deepen a congenital asymmetry ourselves, without having any idea about it. Postural defects, smoking cigarettes and sleeping in the wrong position all do this. So do poorly chosen or poorly performed treatments.

Because fillers can model the face beautifully — provided they are used with moderation and a sense of proportion. Sometimes a small change to one element is enough for the proportions to fall apart.

Identifying the cause is the first step. Without that, there is no point in choosing a method.

Aesthetic medicine does not treat every asymmetry

This is an important distinction, because it saves time and money.

A very asymmetrical face may require the intervention of a plastic surgeon. Asymmetry of the mandible, in turn, is usually a matter for an orthodontist. And where muscle rehabilitation is involved, a doctor or a physiotherapist is needed.

And one warning here. It is not hard to find videos online with exercises and massages "for facial asymmetry". Doing them on your own can do more harm than good. For rehabilitation to make sense, it has to be selected by a specialist — you need to know which muscles to work on, and to do it very precisely.

At the Dr Kuschill MEDESTETIS clinics we set the strategy during a consultation with a doctor. The doctor either selects the treatments or refers you to the right specialist. A holistic approach is our hallmark.

What can be done about it

In the treatment of facial asymmetry there is no single universal solution. Each of us is different. Asymmetrical eyebrows are approached differently than asymmetry of the cheeks.

Below are the four methods reached for most often.

What we do in our clinics:

• Hyaluronic acid — Injection of cross-linked hyaluronic acid with a fine needle or a cannula into selected points on the face · Most often we inject in the area of the temples, cheeks, nose, lips or chin. · The effect lasts about 12 months.
• Calcium hydroxyapatite — Microspheres of the mineral suspended in a gel, administered with a needle or a microcannula at the site of tissue loss. The product gives both a filling effect and skin stimulation. The effect lasts about 12-18 months.
• Botulinum toxin — Administered with a microneedle into the muscles just under the skin; it blocks the release of acetylcholine and weakens excessive contraction · Asymmetry caused by muscle contraction, abnormal muscle structure or facial nerve palsy: drooping corners of the mouth, asymmetry of the masseters, asymmetry of the eyebrows · The eyebrows and the corners of the mouth usually 3–4 months, the masseters longer.
• PDO threads — Implantation of polydioxanone threads using a microcannula. The treatment is performed to correct asymmetrical eyebrows or corners of the mouth.

Hyaluronic acid — the most versatile tool

Hyaluronic acid is a glycosaminoglycan. It sounds intimidating, but it is a substance that binds water in the skin and is responsible for its hydration.

As a filler we use cross-linked hyaluronic acid. It stays in the tissues — for up to 12 months.

The treatment starts with a detailed analysis of the face in terms of proportions. We look not only for the points that spoil the symmetry, but also for the assets worth emphasising.

Then we apply an anaesthetic cream. Thanks to this the punctures are practically painless.

What to expect after you leave the office? Slight swelling may persist for two to three days. Sometimes local bruises appear — they disappear within a few days.

Symmetry improves immediately. The full effect is visible after two weeks, once the hyaluronic acid has settled well at the injection site and the marks from the punctures have gone. After a year it is worth repeating the treatment to maintain the effect.

There is one more complication — rare, but serious: the product can enter a blood vessel and block it. The skin then turns pale, hurts more than it usually does after a needle prick, and after a few hours a bluish, marbled pattern appears. The temples and the nose, which are the areas we most often correct in asymmetry, are among the most vulnerable. If you notice such symptoms after the treatment, contact the clinic straight away — hyaluronic acid has an antidote, an enzyme called hyaluronidase, and the outcome depends on time.

Calcium hydroxyapatite — when durability matters to you

It is a mineral that occurs in our bones and teeth. It forms their scaffolding.

In aesthetic medicine it acts as a filler, much like hyaluronic acid. It is used to correct disproportions — asymmetry of the cheeks, of the mandible.

It comes in the form of microspheres immersed in a gel. They are administered with a sterile microneedle or microcannula, straight into the place where the tissue loss needs to be replenished.

The treatment is painless — an anaesthetic ingredient has been added to the product. It requires no recovery time at all.

The effect lasts from 12 to 18 months.

Botulinum toxin — when the muscles are to blame

Sometimes asymmetry does not come from a lack of volume, but from muscle contraction. Or from an abnormal muscle structure. Or from facial nerve palsy. In that case a filler will do nothing — what is needed is something that relaxes the muscle.

Botulinum toxin blocks the release of acetylcholine — the substance that carries the signal from the nerve to the muscle. The neurotransmitter is still produced, but it is not let out of the nerve ending, so the muscle stops contracting excessively.

This is a reversible process — muscle strength at the motor end plate fades, but not forever. Botulinum toxin is a prescription product and it has its contraindications: we do not administer it during pregnancy or breastfeeding, in diseases of the neuromuscular junction, or in case of allergy to the ingredients of the preparation. That is why at the consultation I ask about medications and chronic conditions.

This makes it possible to smooth out drooping corners of the mouth or asymmetry of the masseter muscles. The botox administered gradually weakens the muscle and reduces its volume, and with it the disproportion.

The most common problem, however, is eyebrow asymmetry. If muscle contraction is to blame, an application of botox will quickly relax them and the defect disappears.

The doctor selects the dose individually. The product is introduced with a microneedle into the muscles located just under the skin.

Does it hurt? Practically not — we use local anaesthesia, and most patients compare the injection to a mosquito bite. The treatment is safe and minimally invasive, so it requires no recovery time. You can usually return to normal activity straight away.

How long does it work? On the small mimic muscles — the eyebrows or the corners of the mouth — the effect usually lasts 3–4 months. On a strong masseter muscle it lasts longer, up to six months and more. During that time new neuromuscular endings form, which is why the treatment has to be repeated regularly, and we set the schedule of repeats separately for each area.

A separate case is asymmetry after a facial nerve palsy. Here botulinum toxin is often administered on the healthy side — to weaken the muscles that work too strongly and pull the face over towards themselves. The best results come from combining the injections with rehabilitation of the facial muscles led by a physiotherapist. This is long-term treatment, planned after a neurological assessment, and not a single procedure.

PDO threads — a lift that evens things out along the way

This is above all a skin lifting treatment. But applied skilfully it can correct asymmetrical eyebrows or cheeks.

It consists in implanting under the skin, with very fine needles, dissolvable threads made of polydioxanone. The threads tighten and lift the skin, correcting minor asymmetries along the way.

The treatment is performed under local anaesthesia and leaves no scars. Swelling may persist for a few days, and sometimes small dimples of the skin appear or the thread becomes palpable. When asymmetry is being corrected this matters, because such changes can themselves upset the proportions — they usually resolve within a few weeks, and if they do not, come in for a check-up.

When it is worth making an appointment with a doctor

Before we move on to the list, one thing matters most. If the facial asymmetry appeared suddenly, within minutes or hours — especially when it comes with a drooping corner of the mouth, slurred speech, weakness in an arm or vision disturbances — do not book a consultation, call 112. These may be symptoms of a stroke, in which every minute counts. Sudden weakness of the muscles on one side of the face without other symptoms also calls for an urgent medical appointment, not an aesthetic treatment.

Book a consultation if:

• the difference between the halves of your face is clearly visible and bothers you
• the asymmetry appeared suddenly, after an injury
• you suspect the problem lies in your bite or in your mandible

During the visit the doctor will analyse your face and propose a treatment.

It is not about an ideal

For many people an asymmetrical face is a source of insecurity from childhood onwards. And it is a problem you can get rid of quickly and painlessly. It is not worth putting off — with age all asymmetries, including the entirely natural ones, become more visible.

It is not about everyone being perfect. It is about everyone feeling good in their own body and not worrying about how they are perceived.

Asymmetry resulting from differences in volume we correct with facial volumetry — the plan is always preceded by a medical consultation, because it is the consultation that determines where the asymmetry comes from.

This article was prepared by Aneta Bembenek, MD.