Q: Dr. Eppley, I am interested in creating a more symmetrical look to my face via fillers and eventually implants. As a result of my jaw being asymmetrical, the right side of my lower face appears fuller and more defined than the left. I have attached some pictures for you to see.
A: Thank you for sending your pictures. I have taken a careful look at them and the fundamental issue is that the two sides of your face are different. The asymmetry is that the entire right side of the face is lower than that of the left. This can be seen from the eyebrow down to the bottom of the lower jaw. the right eyebrow is lower, the right orbital box and eye is lower as well as the lower eyelid, the cheek is lower and more recessed and the inferior border of the mandible is more inferiorly positioned. In short, you have a classic case of facial asymmetry where the two halfs have developed differently. For the sake of any correction, you have to take the position that the left side of the face is the good side or the objective for the right side to try and achieve. No form of injectable filler can make any significant difference in such facial asymmetry. A variety of surgical procedures can be considered from top to bottom including right endoscopic browlift, right orbital floor-infraorbital rim implant, right lower eyelid tightening by canthopexy, right cheek implant and right inferior border mandibular shave reduction.
Dr. Barry Eppley
Q: Dr. Eppley, I have a facial asymmetry problem. Even though I know that everyone has a little asymmetry to their face, mine is not that little. It is quite visible. My cheek bone on the right is a little higher than that of the left. So is the eyeball area above it. I also don’t like my very bushy eyebrows and my left eyebrfow is lower than my right side. My left ear is lower than my right one and that makes it difficult to wear glasses or sunglasses comfortably. I am attaching a frontal picture for your assessment and recommendations. I am leaving this up to you as there seem to be few doctors that know how to treat facial asymmetry and because of your good reviews plus you can help me in all my problems.
A: Thank you for sending your picture and expressing your specific concerns. Your overall issue is one of facial asymmetry with the left orbito-maxillary region as a unit being lower on the left side. The lower positioned left ear would be part of that overall problem. As a general concept to gain better facial symmetry, the lower facial side has to be raised rather than trying to lower the higher side as that is surgically more possible.
With the objective of raising the left sided facial issue, I would make the following recommendations/thoughts. The left ear could be raised somewhat through suspension sutures from the cartilage to the fascia. A slight setback of its protrusion (sticking out) may be considered. This would be done through an incision on the back of the ear. A left eyebrow lift could be through an upper eyelid approach (transpalpebral browlift) which is the most common approach in men. I would remove a slight amount of left upper eyelid skin (blepharoplasty) which also serves as the access for the browlift. The lower eyelid marginj could be raised slightly on the outside with a lateral canthopexy/lid wedge excision. Raising the eyeball, even a few millimeters, can be difficult but a small orbital floor implant could be placed for a slight lifting effect. A small cheek implant would be used to provide some upper cheek fullness. Eyebrow waxing can be done to reduce fullness and are a good start to determine if their thinning is aesthetically advantageous. If so, you can then consider laser hair removal which is best done locally due to the need for a series of regularly spaced treatments to get some permanent reduction.
Although all of the individual surgeries are small in nature, they can collectively make a noticeable difference. All os this is said with the understanding that your facial asymmetry can be improved but a perfect match to the right side is not possible.
Dr. Barry Eppley
Q: I am trying to make my face symmetrical. My jaw is not aligned, making my mouth and smile crooked and my nose is wide with a pronounced bump. I have attached some pictures for you to evaluate, image, and give me recommendations as to what to do. Thanks!
A: An analysis of your pictures shows that you do have a deviated nose with a hump and a wide tip. But in addition, you have left facial hypertrophy. This is the origin of why you feel that your jaw and smile is crooked. The left side of your face, from the orbit down to the jaw angle is bigger and wider. This creates your facial imbalance/crookedness. I have done some imaging of your rhinoplasty, with and with adjustment of the left facial enlargement. In facial asymmetry it is always a question as to whether to build up the smaller side or reduce the bigger side. In your case, I think it is better to try and make the larger side smaller through cheekbone and jaw angle reduction. This is shown in your rhinoplasty front view imaging, both with and without it being done. From a side view, I have also added a small chin augmentation as your profile shows some mild horizontal chin deficiency.
I think the combination of rhinoplasty, cheekbone and jaw angle reduction and chin augmentation can make for a more symmetrical and balanced face. This will not change the asymmetry in your smile as that is soft tissue-based and can not be adjusted like the underlying harder facial structures.
Dr. Barry Eppley
Q: Hello Dr. Eppley, I have many problems related to my face. Firstly, my jaw is asymmetrical. Right side of my face/jaw is smaller than the left side. Therefore, my jaw is slanted to the left. My nose is deviated. Secondly, I have prominent zygomatic arch but my cheeks are hollow. My eyes are also deep probably due to my prominent brow bone. Beside my jaw, my left and right profiles are different. Back of my head on right side is flatter and hairline in the temporal area is different. How can these problems be solved? I want a more balanced face, in fact a more balanced skull, a flatter forehead, stronger and symmetrical jaw. I also want to have strong cheekbones but maybe a narrower midface. In addition to my photos, I also added photos of the face type that I want to have. Of course it is impossible to have the exact same face but similar facial features and proportions are what I think of. To what extent it is possible?
A: In trying to achieve improved facial balance it is important to focus on those features that can be changed without causing a lot, if any, surgical scars to do. This makes the improvement of jaw and cheek asymmetries capable of being improved with jaw angle and cheek implants that can be placed through the mouth. Similarly, cheekbone reduction can be done through combined incisions inside the mouth and from the temporal hairline. A rhinoplasty, open or closed, can be reliably done for better midline nose alignment and shape changes. Brow bone reduction, while commonly requested by men, is a more difficult choice because there is no ‘scar-free’ way to do it ( a scalp incision is needed) even though the procedure is very reliable at lessening the prominence of the brows. Skull augmentations may be able to be done through an injectable cranioplasty technique depending upon the degree of skull flattening.
When it comes to the potential of face changing surgery, it is best to think of altering and improving the foundation of what you have…not facial transformation.
Dr. Barry Eppley