Facial asymmetry: what it is and how to assess it

Facial asymmetry is the difference between the right and left sides of the face. Every face has some: one eye slightly higher, one eyebrow more arched, one side of the jaw more defined, a corner of the mouth that rises more when smiling. In most cases, these differences are subtle and part of the person's identity.

The causes vary: bony and dental differences, chewing pattern, uneven muscle strength, asymmetric volume loss with age, sequelae of trauma or paralysis, and even the side the person usually sleeps on.

Why record the asymmetry before the procedure?

Many patients only notice an asymmetry after a procedure, because they start looking at their face more closely. If it is not documented, the complaint falls on the injection. For this reason, the assessment should:

• identify and show the asymmetries to the patient before starting;
• record standardized photos, with the same light and position;
• note in the patient record what is baseline and what will be treated.

How does asymmetry change the plan?

Differences in volume, such as a cheekbone that is less projected on one side, can be softened with different volumes per side. Asymmetries of bony, dental or neurological origin have a limit and may call for other specialties. Toxin can also cause or correct an asymmetry of expression, depending on the dose and the points.

In Harmy

In planning, the volume in ml of a bilateral region is the total, split between the two sides in the projection. Differences between sides are left to the professional's discretion at the injection. The frontal photo in Harmy also serves as a baseline record, and "Add actual result" allows comparing with the result afterward.

Also called: lack of symmetry, asymmetrical face.