Almost everyone has some facial asymmetry: one eyebrow may sit higher, one eye may look smaller, or the nose or smile may deviate slightly. This is normal. Asymmetry can become more noticeable with ageing, dental changes or injury. However, a new, sudden droop of one side of the face is a medical emergency and may indicate a stroke or Bell’s palsy.
Normal facial asymmetry
The two halves of the face develop separately and are never identical. Differences in bone, muscle, fat and skin create mild asymmetry that most people never notice until they see themselves in photographs or selfie cameras, which reverse the image and distort proportions. Mild asymmetry is part of what makes a face individual and natural-looking.
Common causes of asymmetry
- Genetics and development: natural differences in the jaw, cheekbones or eye sockets.
- Ageing: uneven loss of volume, skin laxity and descent of tissues can make one side look older.
- Sleeping position: consistently sleeping on one side may contribute to creases on that side.
- Dental factors: tooth loss, jaw alignment and chewing on one side.
- Sun damage and smoking: which can affect the skin unevenly.
- Injury or previous surgery: fractures, scars or earlier procedures.
- Nerve problems: facial nerve weakness can cause one side to droop.
Red flags: sudden facial droop
If one side of the face suddenly droops, call 999 immediately. Use the FAST test: Face drooping, Arms weak, Speech slurred, Time to call 999. Stroke is a time-critical emergency. Bell’s palsy, which causes weakness of one side of the face, also needs same-day medical assessment, as early treatment may help, but stroke must be ruled out first. Seek prompt GP advice for gradually developing asymmetry with a lump, pain, numbness or twitching.
Non-surgical options
Dermal filler can balance mild differences in cheek, lip, chin or jawline volume. Anti-wrinkle injections, given by a qualified prescriber, can soften muscle activity on one side, for example to even out an eyebrow position or a lopsided smile. These treatments are temporary and require maintenance. They can improve balance but cannot correct major bony differences.
Surgical options
When asymmetry is caused mainly by ageing, a facelift can reposition the deeper tissues and remove excess skin, and each side can be tailored individually. Blepharoplasty can address differences between the eyelids, rhinoplasty can improve a deviated nose, and fat grafting can restore volume where it has been lost. Significant bony asymmetry of the jaw may need specialist maxillofacial assessment. Mr Nassab will explain which aspects of asymmetry are likely to improve; it is important to know that some asymmetry will remain after any procedure.
Realistic expectations
The aim of treatment is better balance, not perfect symmetry, which does not occur naturally. Pre-existing differences can sometimes be more noticeable after surgery as other features are improved, so careful photographs and discussion before treatment are important. Some people find that simply understanding their asymmetry is normal is reassurance enough.
What happens at a consultation
Mr Nassab will take a history of when you first noticed the asymmetry and whether it has changed, examine the bone structure, soft tissues and facial movement, and take standardised photographs. If there is any sign of a nerve problem, dental issue or underlying medical cause, you will be advised to see your GP or an appropriate specialist first. Treatment planning focuses on the features that bother you most, with a clear explanation of what is and is not likely to change.
Recovery and cost
Recovery depends on the procedure. After a facelift, most people need around two weeks before they feel comfortable in public, and swelling continues to settle over several months. A facelift costs from £14,500; a deep plane face and neck lift from £18,500 and a mini facelift from £8,000. Dermal filler is not performed by Mr Nassab; at CLNQ it is provided by CLNQ’s non-surgical doctors and priced separately. The consultation fee of £150 is separate, and cosmetic surgery is for adults aged 18 and over.
Frequently Asked Questions
Is it normal to have an asymmetrical face?
Yes. Virtually everyone has some asymmetry, and it is a normal feature of human faces.
Why does my face look lopsided in selfies?
Front cameras reverse and distort the image at close range, which exaggerates asymmetry you would not normally notice.
When is facial asymmetry an emergency?
Sudden drooping of one side of the face, especially with arm weakness or slurred speech, needs a 999 call.
Can a facelift correct asymmetry?
A facelift can improve age-related asymmetry by tailoring each side, but it cannot create perfect symmetry or alter bone structure.
Can filler correct facial asymmetry?
Filler can balance mild volume differences. The effect is temporary and it cannot correct major bone differences.
