Q: Dr. Eppley, I am interested in correction of numerous facial deficiences which all are located on the left side of my face. Attached are 3 pictures of my face that show the areas of concern. I took one straight-on picture and another two pictures each showing one side of my face.
When looking at the straight-on photo, you can see that my jaw is skewed to one side with the right side being fuller than the left. You can also see that my chin is tilted to one side as well. What is slightly harder to see in the photo is that there are some soft tissue discrepancies between my cheeks and if you can see, there is a slight “indent” on my right side that isn’t there on the left. I thought that this could be because of the prominence of the mandible underneath and the prominence of the cheekbone above that creates this indent but I would love to hear your opinion on it as well. The deficient cheekbone that I mention is on the left and it may be difficult to see without being in person or taking a picture at a very specific angle. However, you can easily see that the zygomatic arch on the right is more prominent and that holds true to the entire cheekbone as well. I cannot wait to hear your opinions on these pictures. Again, thank you for your time.
A: Thank you for sensing your pictures. I can not disagree with any of your observations about your face. What you really have is a near total left-sided facial asymmetry which affects many structures from the ear to cheek and down along the jawline. The facial asymmetry is greatest at the jawline and lessens as it ascends superiorly towards the eye. Undoubtably, as is often the case, they are heavily bone-based with some soft tissue component to them.
On a practical basis one starts by addressing the skeletal issues and the use of 3D CT scanning and the design of custom jawline and cheek implants is really the only way to effectively treat it.
Dr. Barry Eppley