How Can My Crooked Smile Be Fixed?

Q: Dr. Eppley,  I’m 22 years old and I’m looking for help with facial asymmetry. I have one eye slightly higher than the other, uneven cheeks and smile lines, and a mouth that shifts when I talk.

I’ve been told this is natural and can’t be fixed, but I believe it affects my confidence and quality of life. I’m interested in understanding whether facial balancing surgery or structural correction could help in my case.

I have had facial asymmetry since childhood. I feel that one side of my face appears straight, while the other side looks slightly curved — similar to how hands look when raised in prayer, with one side more inward or rounded.

This difference becomes more visible when I talk or smile, as my face shifts more to one side. I believe the issue may be due to bone structure or muscle imbalance.

Could you please tell me if this kind of facial asymmetry (possibly involving zygomatic bone or jaw alignment) can be corrected through surgery or other treatments?

A: While you have numerous facial asymmetries, as you have mentioned, most of them do not justify surgical intervention as they can not be completely corrected. I don’t think surgery is worth the effort. The exception is your twisted smile which is the result of congenital paralysis of the left marginal mandibular branch of the facial nerve. Your left depressor anguli oris muscle does not work which is why the left lower lip is higher than the right at rest and pulls up even higher as the right lower lip when smiling pulls it to the right. While you can never make the nerve work to activate the depressor muscle you can do a vermilion advancement of the left lower lip to partially camouflage the severity of the smile asymmetry by evening out the amount of vermilion show at rest. 

Dr Barry Eppley

World Renowned Plastic Surgeon