On Facial Asymmetry
3 December 2019 onur
The human body is almost symmetrical.
The human face is almost symmetrical, too.
I say “almost” because we cannot speak of an “absolute” symmetry neither in our body nor in our face.
As a rule, the right and left sides of the face exhibit “minor” differences from each other at all times and in everyone. There are millimetric differences between eyes, ears, lips, eyebrows, chin contours, bone structures and almost all facial structures.
The air spaces in the face are not of the same volume. Mimic and chewing muscles in the right and left halves of a face are not of the same strength and size. The structures inside the face are asymmetrical.
In addition to developmental differences, the right and left halves of our face are not exposed to the same physical factors at the same intensity throughout our lives. The more sun-exposed side will age more. The side you sleep on will be looser. The facial wrinkles will be deeper on the half of your face where your mimic muscles are more active. The temporal area volume will decrease faster on the side where you chew more intensely due to chronic compression.
Imagine taking a photo of a person’s face from the opposite and then dividing this photo in half. Imagine obtaining a full face by mirroring the right half, and a full face by mirroring the left half. As we evaluate facial asymmetry, we do this half-face comparison study on digital photographs. Each time we reach the same result that astonishes the patients. Full faces obtained from the right and left of halves of the face almost look like two different people.
In daily life, people do not notice such natural asymmetries in their own faces or other people’s faces. If you give a face a critical eye, you can definitely spot the differences between the two halves of the face, but the factory settings of our brain for symmetry are not at a millimetric precision but rather measures things in centimeters.
Factory settings can be changed.
However, this is not recommended by either the manufacturer or the technical service (plastic surgeons).
A plastic surgeon, photographer or director dealing with facial aesthetics may perceive millimetric differences more routinely. Dentists’ precision to detect millimetric differences in tooth alignment is highly advanced. However, you should know that there is a reason for the factory settings to have millimetric precision. This is because no face presents millimetric symmetry in nature.
When a person starts to examine their face by reducing their body perception settings to the level of “millimeters”, they will notice minor asymmetries on their face that no one else notices, and this will cause them to become uncomfortable with these over time and even become obsessed with this “natural” state.
Patients can be at peace with themselves in saying, “Professor, I am obsessed with symmetry.” This is usually an expression of the individual’s self-definition of themselves as a “perfectionist”. We plastic surgeons suspect that a person who says they are obsessed with symmetry has a “body image disorder”. Most of the time, we do not want to treat patients in this group.
That is because it is very, very rare for a surgical procedure to produce a completely symmetrical result in plastic surgery. In particular, facial aesthetic surgeries almost always result in minor asymmetries.
It is not possible for a facelift, an eyelid surgery, an ear surgery or even a nose surgery to produce an absolutely-symmetrical result.
Even if the impossible happens and – say – you get a perfectly symmetrical nose after nose surgery, this perfect nose will be at the center of an asymmetrical face. As patients often say, the nose will look different on the right and left views. This is because it stands on different platforms.
It is extremely important that our candidate patients who are interested in plastic surgery fully understand the concepts of normal symmetry/normal asymmetry of the face.
In plastic surgery, we frequently deal with the real asymmetries of the face. Hereditary developmental disorders of the skull and facial bones may lead to very pronounced facial asymmetries. For instance, cleft palate and lip (harelip) deformity is seen in one out of every 1000 births and may cause a significant right-left asymmetry in the mouth, chin, lips and nose.
There are various diseases that cause asymmetric absorption of facial soft tissues in adulthood. For instance, in hemifacial atrophy, half of the face collapses. In scleroderma, the skin in some areas of the face “melts” and thins in the form of plates.
Facial traumas, certain facial infections, burns, facial tumors, vascular anomalies, facial surgical interventions and facial radiotherapy may cause significant asymmetries. Plastic surgery is the science that treats such asymmetries. Dealing with facial asymmetry is part of our job. On the other hand, although the target is to achieve facial symmetry within the normal limits in obvious asymmetries, it is often not possible to achieve this target.
- If there is an asymmetry on your face that attracts attention at first glance,
- If this asymmetry can be made less noticeable with the options we have,
- If you are confident that you fully understand the limitations of operations and the concepts of normal symmetry/asymmetry of the face,
you may be a candidate for surgical treatment to eliminate facial asymmetry.
Finally, the point that should be emphasized is that all facial aesthetic procedures carry the risk of creating an asymmetrical result on your face. Most of the time, postoperative asymmetries will be normal facial asymmetries. However, asymmetries that need to be corrected via secondary interventions may occur in the postoperative period. Secondary intervention may sometimes be too risky/difficult to correct a minor asymmetry. Some asymmetries may not be corrected at all.
Please feel free to contact us for detailed information on facial asymmetry.
Take good care…
… of yourself and your beauty.