You may feel like you’re the only person on the planet with facial (or body) features that don’t match, but you’re not. Most of us have some degree of asymmetry somewhere on our bodies, and it is totally normal. But a few millimeters difference can be enough to make some people feel like their face or body is askew. When that is the case, a temporary fix or even surgery may be what the doctor orders.
Why Asymmetries Occur
To understand why asymmetries happen, let’s take it back to human biology 101 for a minute. In utero, two plates fuse together to form the face. However, rarely is there a perfect fit, and often, barely visible asymmetries form. Development continues during puberty, which is why some teenagers notice inconsistencies in their nose or eyes.
From there, aging takes its course. Bone density and muscle tone are lost, and fat shifts down the face, leading to more obvious imbalances. “Asymmetries can develop from muscles that are slightly stronger on one side of the face than the other,” explains New York facial plastic surgeon Konstantin Vasyukevich, MD. In addition, injuries, trauma, environment and even lifestyle choices can cause a disproportionate look. “Sleeping on one side of the face, chewing more on one side, weak supporting ligaments, and dental loss can enhance asymmetries, too,” explains Palo Alto, CA facial plastic surgeon Jill Hessler, MD. Poorly done fillers, thread lifts and surgery can also elevate one area more than another.
A minor disparity doesn’t mean the face or body is unappealing. “Asymmetries are a part of the beauty of human beings,” says Miami plastic surgeon George Varkarakis, MD. Yet, personal perception determines what we see as asymmetrical, which differs for each part of the face. “The eyes are the most noticeable, even with the slightest difference. However, the cheeks can be quite asymmetrical, yet seen as perfectly fine,” he adds.
Does Perfect Symmetry Exist?
Almost everyone bears some sign of asymmetry, further solidifying that perfect symmetry does not exist. But, that doesn’t stop individuals bothered by off-kilter features from fixing them. La Jolla, CA plastic surgeon Robert Singer, MD tells his patients who wish to be more symmetrical: “Welcome to the town of symmetry where the population is zero. Patients expect to be perfectly symmetrical, and while significant asymmetries may be improved, perfect symmetry is usually not possible.”
So, if we all show some extent of asymmetry, why is it more evident on some than others? Beverly Hills, CA facial plastic surgeon Kimberly Lee, MD says asymmetries closer to the midline of the face are less noticeable than those farther to the side. “These discrepancies can become bothersome when the eye notices them as being off, which is usually more than 1 millimeter.”
Some procedures can improve facial balance, but minor unevenness will prevail after correction. Attempting to make any feature a replica of itself leads to a contrived look. So, while patients strive for perfection, most plastic surgeons choose to retain subtle asymmetries for natural results. “The closer we get to the concept of balanced harmony, the more aesthetically pleasing a patient looks,” Dr. Singer explains.
From quick fixes to surgical solutions, the best approach to improving asymmetries depends on where they exist and their size and cause. “Every person decides for themself when inquiring about corrective procedures,” says Brooklyn, NY plastic surgeon Roman Rayham, MD. These are the tried-and-true options to choose from.
The strategic application of makeup can create the illusion of a balanced face. Celebrity makeup artist Monika Blunder says darker shades recess or push back facial features while lighter shades bring them forward. Using cream concealer, contour and highlighting creams or powders, or foundation, apply makeup to either highlight or downplay those features. If one eye is shorter or droopier than the other, Blunder says eyeliner can help. “Exaggerate the flick on the smaller eye and go lighter on the eye you’re trying to match.”
02: Injectables + Fillers
Hyaluronic acid fillers are a fast fix for a minor discrepancy in the nose, cheeks, lips, and jawline. Dr. Rayham injects filler into the soft tissue of the face to make certain features look similar to the opposite side. “For example, I fix lip asymmetries by placing more filler in one side of the lip versus the other.” Neuromodulators can also help balance out uneven eyebrows and wrinkles. If you’re more one-and-done, a fatstimulator like Renuva (a matrix injected like filler) can reinstate volume for up to 10 years in areas that inherently contain fat, like the face and breasts. “This is a promising technology, but we still need data of long-term efficacy,” says Dr. Singer.
Fat lasts longer than any filler or injectable. Harvesting a patient’s fat and injecting it into a deficient area eliminates inconsistencies in the stomach or thighs while smoothing out areas where it is placed, like under the eyes or in the cheeks. Using fat in the breasts can make them more symmetrical and give a slight boost in volume and size.
“Welcome to the town of symmetry where the population is zero. Patients expect to be perfectly symmetrical, but that’s usually not possible.”Dr. Singer
The implant route corrects significant facial asymmetries in the jaw, cheeks and chin, but Dr. Lee says the only way to correct asymmetries using implants (usually manufactured to be symmetric) is to use different-sized ones that can accommodate disparities.
05: Cosmetic Surgery
One of the goals of plastic surgery is to create better proportions. In the case of facial asymmetry, Dr. Lee says it’s essential to take photos of the patient and create a 3-D avatar of their face. “Using cutting-edge technology, I split the face in half and put two right sides of the face together and two left sides together to create two mirror images, which makes any asymmetry more obvious. Often, the asymmetry is only off by a couple of millimeters, so when the risk outweighs the benefits, I advise patients of that.” While surgery aims to create as much balance as possible, Dr. Lee never promises perfect symmetry, because she says that, in most cases, it’s nearly impossible to achieve.
06: The Eyes
Blepharoplasty is the gold standard for correcting eyelid asymmetries. “Removing different amounts of skin and fat from the eyes results in a more balanced appearance,” says Dr. Hessler.
07: The Nose
Structural differences, like a deviated septum in one side of the nose, can cause the external to look uneven. Dr. Lee explains if one nostril is lower than the other, raising or lowering one side surgically can improve the asymmetry.
08: The Lips
Dr. Varkarakis says the right side of the midface is usually shorter than the left side, which affects the lips’ position. “The left side of the lip may look more curved than the right side.” A few filler injections can temporarily correct the pink part of the lips. When filler doesn’t cut it, a lip lift may help. “It provides long-lasting change and corrects the imbalance of the length of the lip,” Dr. Hessler adds.
09: The Eyebrows
Think of the eyebrows like cousins, not twins—they’re not perfect replicas of one another. “In some, patients, the right side of the forehead has more surface area than the left, affecting the position of the eyebrows. Most patients I see have a higher left eyebrow because the frontalis muscle is smaller on that side, so there is more muscle activity,” explains Dr. Varkarakis.
Neuromodulators can lift the brows to make them appear more even, and a noninvasive treatment like Ultherapy is also an option. “We can use it with varying levels to create lift,” Dr. Hessler says. A browlift may be the best solution for more severe inconsistencies that crowd the upper eyelids.
10: The Breasts
It’s not uncommon for one breast to be larger, perkier, rounder or fuller than the other, and even the nipples may not match up. The rules of breast asymmetry are anything but standard, which is why various procedures may be combined to achieve a more harmonious look. “Sometimes, we need to lift one side or add an implant, or use differentsized implants or fat to even out the breasts,” Dr. Singer explains.
11: The Hips, Flanks + Butt
Indifferences in the lower body can make one side appear more prominent. “When patients have asymmetries in the size of their hips or flanks, we can use liposuction to take out fat,” says Dr. Singer. “We can add fat to areas where there are depressions, too.”
12: New Technology
The first-of-its-kind EmFace treatment employs radio frequency and High-Intensity Facial Electrical Stimulation (HIFES), which Denver dermatologist Joel L. Cohen, MD, who participated in the clinical trials says, “tones and lifts various areas of the face with the RF heating and by enhancing the musculature that holds facial retaining ligament interconnections—so it’s like tightening the weave of a lax hammock.”
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