Why is one side of my face sagging more than the other? (Photos)

Question

I've noticed that the right side of my face is showing a more prominent sign of sagging around the smile line area. It seems almost as though the skin is thinner there and there isn't much elasticity. If I push on it it will make the wrinkle worse and it won't bounce back. Almost like the skin collapses there. It also looks almost like an indent in photos. As you may also see, I have some loss of fat under my eyes. Is there anything I should do about it? I don't want to look older than I am.

Edgardo Zavala, MD · Answer

In general your face seems quite nice. Symmetry is never perfect. If anything what I see is incipient tear trough under your eyes. A filler expertly placed can give an amazing rejuvenation, in my experience with the use of a permanent filler such as Bellafil, placed with a cannula deep below the orbicularis muscle is the best option. 
Best wishes

Raffy Karamanoukian, MD, FACS · Answer

Morpheus 8 is a non-invasive skin and soft tissue tightening treatment that is consistently amazing in our patients. We use the Morpheus to exact fractional induced RF into the skin or tissue in order to tighten collagen and stimulate contraction of the tissue. For acne scars, it is quite useful to build collagen in patients who have atrophic scars but is not very productive for ice-pick scars which require TCA Cross. For tissue tightening, Morpheus is ideal for the face and neck and we often combine it with CO2 laser or Ultherapy to further enhance results. Chemical peels and skin resurfacing should be done at least 5 to 7 days after, but can be performed earlier, depending on treatment severity. Avoid exfoliating skin treatments before Morpheus and expect a period of 2-4 weeks for skin contraction to set in.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian 
Realself100 Surgeon

Jason Emer, MD · Answer

This is my expertise and a huge portion of my practice. Asymmetry is normal and expected. Buccal fat pad gives slimming not symmetry. Masseter botox will make you slimmer and make the jawline more loose. Fillers help give shaping and contouring. If you want perfect or close to perfect symmetry you need maxillofacial surgery or implants customized. I suggest seeing an expert to go through all options. Most of my younger clients use fillers to give them shaping especially on the cheeks, jawline, and chin which make the face look more slim and tight; and threads such as PDO or Instalift can build collagen and support the facial shaping and skin looseness over time, slowing down the aging process and given the face a more “snatched” look; and morpheus8 or PiXel8 deep microneedling RF can tighten crepe skin especially on the neck and jawline and is great for long term tightening of the full face, neck and chest; its often used to give the face a slimmer more sculpted look because it tightens the skin and gives lift. an early face lift can be performed as well even in younger clients if they want a different facial shape, maxillofacial surgery with bone breaking or shaving can also be done. For facial slimming a combination of treatments are always needed. Options include: 1. Buccal fat pad removal to reduce fat on the lower face 2. Factite or Renuvion/J Plasma to tighten the lower face, jawline, and chin to reduce fat and give the jawline and neck tightening and shaping. 3. Botox to the masseter to reduce the muscular size of the jaw giving the face an illusion of being more slender 4. Fillers to the jawline, chin, cheeks, temples and brow help to shape the face and make it more angled and defined Always use at home derma rolling (see link to Emerageskin x anteageMD roller plus stem cells/hyaluronic acid ampules) and peels like emeragecosmetics enlighten or aerify that can be used to improve skin quality and tighten the skin while improving wrinkles, pigmentation, acne, and Melasma. See an expert who does facial shaping with surgical and non surgical methods to get a comprehensive option. Best, Dr. Emer.

Shanthala Shivananjappa, MD · Answer

Facial asymmetry is not an unusual finding in most people. The sagging and wrinkles are more pronounced on one side due to sleeping pattern, sun exposure, collagen and volume loss or repeated facial expression. Have a consultation with an expert aesthetic physician and explore the procedures that can prevent, correct  early aging.

Fadi Nukta, MD · Answer

Thank you for your question! There is no reason to be concerned as the face is never symmetrical. Sagging can also be a sign of premature aging. The face can age in many different ways including changing shape and volume loss.  To prevent and even correct this I would recommend getting started on a skin care regimen that will focus on anti-aging like serums, corrective moisturizers and sunscreen. Other options are getting regular facials and mild chemical peels to maintain healthy young skin. There are more intense options like fillers and lasers but those can be more harmful than helpful to younger skin.

Onir Spiegel, DDS, PhD · Answer

Hi RealSelf fan, 
It is very normal to have one side of the face different than the other.  We are not all created equal and symmetrical :-)   Good thing we've got Fillers (It's not like our moms had it).  You are a beautiful woman and with one or two syringes of a firm Filler like Restylane Lyft and Voluma layered with a softer filler like Juvederm Ultra or the Restylane Defyne and Refyne, you could overcome this easily and show the world your natural beauty.  Take care!

Why is one side of my face sagging more than the other? (Photos)

Answers (6)

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