Facial Asymmetry: Causes & Treatments

Facial asymmetry can cause both aesthetic concerns and functional problems. Asymmetry can result from genetic factors, trauma, or developmental disorders. Various surgical and non-surgical methods can be applied to correct this condition. Orthognathic surgery, a procedure for aligning the jawbones, is often chosen to address severe imbalances, while jaw-shaping procedures like genioplasty can improve the aesthetic appearance. Additionally, soft tissue procedures such as fat injections can be used to compensate for volume loss. The treatment method to be applied depends on the degree and cause of the asymmetry; therefore, an expert evaluation is of great importance.

What Causes Facial Asymmetry and When Is Surgery Necessary?

Facial asymmetry can be caused by congenital, developmental, and later factors. These conditions can not only raise aesthetic concerns but also be associated with functional problems. Especially in severe cases, surgical intervention is necessary to correct the asymmetry and restore basic functions.

Congenital Conditions:

• Craniocervical syndromes
• Hemifacial microsomia
• Condylar hypoplasia

Developmental Factors:

• Genetic predisposition
• Environmental factors

Later Factors:

• Trauma
• Neurological disorders
• Aging

The need for surgical intervention is usually based on functional or aesthetic needs. Functional problems include difficulties with chewing, speaking, or breathing. Additionally, facial asymmetry can have a negative impact on a person’s psychological health or may be a progressive condition, leading to the consideration of surgical methods. For example, reshaping the face after trauma or early intervention in progressive condylar hypoplasia is important.

However, before deciding on surgery, a comprehensive evaluation must be conducted to accurately determine the cause and extent of the asymmetry. The chosen treatment method is planned considering the individual’s overall health and aesthetic goals.

How Does Orthognathic Surgery Correct Jaw-Related Asymmetries?

Orthognathic surgery is an advanced surgical procedure applied to correct asymmetries in the jaw and facial region. This procedure aims to address both functional and aesthetic problems by repositioning the jawbones:

• Asymmetries of the Upper Jaw (Maxilla): Corrected with Le Fort osteotomy.
• Problems with the Lower Jaw (Mandibula): Addressed with bilateral sagittal split osteotomy (BSSO).
• Jaw Shaping: Genioplasty is used.

These techniques are selected and combined based on the type of asymmetry of the patient. For example, severe imbalances in the midface area can be corrected with Le Fort osteotomy, while problems with the lower jaw can be addressed with the BSSO technique as a supplementary procedure. Genioplasty provides an aesthetic improvement by making the jawline symmetrical.

Orthognathic surgery not only improves appearance but also ensures significant improvements in functions such as chewing, speaking, and breathing. TMJ (temporomandibular joint) disorders, pain, and issues with tooth occlusion can be resolved through this surgery. Advanced technologies, particularly 3D imaging, enable more precise surgical planning and increase the success rate.

What Is Genioplasty and How Does It Improve Jaw Asymmetry?

Genioplasty is a surgical procedure in which the jawbone is shaped or repositioned to improve facial symmetry and aesthetic appearance. Jaw asymmetry can be caused by genetic factors, trauma, or developmental problems. In such cases, genioplasty offers an important solution to correct the jaw structure and align it with the facial contours.

Types of Genioplasty:

• Sliding genioplasty
• Reducing genioplasty
• Augmenting genioplasty

During the procedure, the surgeon can cut the jawbone and move it forward, backward, or sideways. In reduction procedures, excess bone tissue is removed, while in augmentation procedures, the bone tissue can be brought forward or implants can be used. In most cases, incisions are made from within the mouth to minimize scarring. The jawbone is stabilized with screws and plates, completing the procedure.

Genioplasty improves facial balance by correcting the position and shape of the jaw. It is crucial that the jawline is in harmony with other parts of the face to ensure a symmetrical appearance. This procedure significantly contributes to the aesthetic facial profile and has a positive impact on the person’s overall appearance.

In the postoperative phase, swelling and pain can be expected, but these symptoms usually disappear within a few weeks. During the healing process, it is important to consume soft foods and maintain good oral hygiene.

How Do Facial Implants and Fat Injections Correct Soft Tissue Asymmetry?

Facial implants and fat injections are effective methods used to improve the symmetry and aesthetic appearance of the face. Facial implants are used to correct significant bone structure deficiencies, while fat injections offer a more natural approach to addressing soft tissue asymmetry:

Facial Implants:

• Biocompatible Materials: Such as silicone, polyethylene, polytetrafluoroethylene.
• Application Areas: Jaw, cheekbones, jawline.
• Incision Sites: From within the mouth or skin layers.

Fat Injections:

• Process: Fat is harvested from specific areas of the body, such as the abdomen, legs, or hips, and slowly injected into the facial skin lines.
• Advantages: Natural results since the patient’s own tissue is used, minimizing the risk of allergic reactions.
• Objectives:
  • Compensation for soft tissue deficiencies.
  • Improvement of skin quality.

Facial implants provide more permanent and predictable results, while fat injections are more suitable for patients who desire a natural and soft appearance. When both methods are used together, both bone and soft tissue asymmetry can be corrected. The healing process after surgical procedures varies depending on the method used.

What Role Does 3D Imaging Play in Planning Facial Asymmetry Surgery?

Three-dimensional (3D) imaging technology offers high accuracy and personalization options in planning facial asymmetry surgeries. This method allows surgeons to analyze the patient’s facial structure in detail and optimize treatment strategies. Unlike traditional two-dimensional imaging methods, 3D imaging provides more comprehensive information about both the facial bones and the soft tissues:

• Advantages of 3D Imaging:
  • More accurate analyses.
  • Easy detection of small asymmetries.
  • Detailed visualization of facial structures.
  • Pre-simulation of surgical outcomes.

Virtual surgical planning (VSP) allows the operation to be digitally planned using 3D data in advance. This enables the surgeon to identify potential complications during the surgery beforehand and choose the most suitable surgical approach. Additionally, surgeons can virtually test incisions, bone corrections, and tissue adjustments using this technology.

Computer-aided design (CAD) and 3D printing technology enable the preparation of patient-specific surgical guides and implants during the operation. These guides allow surgeons to work with maximum precision during the surgery.

3D imaging is used not only for surgical planning but also for monitoring postoperative results and evaluating success. This objective measurement capability contributes to achieving better aesthetic and functional outcomes.

What Are the Risks and the Recovery Process of Facial Asymmetry Surgery?

Although facial asymmetry surgery offers aesthetic and functional benefits, it also carries certain risks, and the recovery process must be carefully managed. It is important that patients are well-informed and follow the doctor’s recommendations.

Potential Risks of Surgery:

• Infection Risk: Occurs in about 7% of cases and is usually controlled with antibiotics.
• Nerve Damage: Especially in lower jaw surgeries, this can lead to temporary or permanent numbness in about 3.7% of cases.
• Bite Problems: Can occur in 20% of patients, and in some cases, reoperation may be necessary.
• Jaw Relapse: Approximately 9.2% of cases may lead to the jaw position reverting to its original state.
• Overcorrection or Insufficient Correction: May sometimes require revision surgery.
• Scars: Scars from surgeries inside the mouth are minimized, while external scars are rarely seen.
• Swelling and Bruising: Especially with fat injections, these can last for several weeks.
• Anesthesia Risks: Although rare, allergic reactions can occur.

Recovery Process

First 2 Weeks:

• Swelling and Bruising: Are at their peak; it is recommended to keep the head elevated.
• Pain: Mild to moderate pain can be managed with prescribed medications.
• Diet: Soft and liquid foods are recommended.

3–6 Weeks:

• Activities: Light activities are possible, but strenuous exercises should be avoided.
• Follow-Up Appointments: The recovery process is monitored during follow-up appointments.

2–6 Months:

• Swelling: May take a few months to fully subside.
• Nerve Sensation: Recovery of nerve sensation can take time.
• Results: Become noticeable within a few months.

It is essential that patients remain patient during the recovery process and closely follow their surgeon’s instructions to achieve the best results and minimize complications.

Dr. Erman Ak

Plastic Surgeon Dr. Erman Ak completed his primary and secondary education in Mersin and his high school education at Mersin Science High School. He graduated from Hacettepe University Faculty of Medicine as a Medical Doctor in 2014. He started his specialist training at Istanbul University Çapa Faculty of Medicine, Department of Plastic Reconstructive and Aesthetic Surgery in 2014. He performed many successful cleft lip and palate, congenital anomalies and jaw surgery operations at the hospital, which is one of the few jaw surgery centers in Istanbul. These difficult and tiring surgeries helped Dr. Erman Ak create his own concept in facial surgery.