Facial asymmetry: One cheek is fuller and hides my cheekbone and OG curve, What is the best procedure? (Photos)

Question

Hello, I have noticeable facial asymmetry between my left and right sides. My right side has less fat/soft tissue, so the OG curve and the cheekbone are much more visible and defined. On the left side, there appears to be more fat and/or muscle, which makes the OG curve less visible and causes the cheekbone to look less pronounced. The difference becomes especially noticeable when I tilt my head, in certain lighting, and in photos. It looks like one side has a sharper, more defined facial contour, while the other side appears fuller and hides the underlying bone structure. Could this be caused by an imbalance in facial fat, enlarged facial muscles, bone structure, or a combination of these? How would you determine which tissue is responsible for the asymmetry? If the issue is mainly excess fat or muscle on one side rather than bone, what treatment would you recommend? Would Botox, buccal fat reduction, facial liposuction, fat grafting, fillers, or another procedure be the most appropriate? My goal is to make both sides of my face look as symmetrical and natural as possible.

Anna Chacon, MD, FAAD · Answer

First, I'd like to reassure you that some degree of facial asymmetry is completely normal. Nearly everyone has one side of the face that is slightly fuller, more projected, or more defined than the other. The fact that you notice the difference more in certain lighting or when your head is tilted is also very common, because shadows can exaggerate subtle differences.

From your description, it's possible that the asymmetry is due to one or a combination of the following:

Differences in facial fat volume
Differences in muscle size, particularly the masseter muscle
Natural skeletal asymmetry
Variations in the way the soft tissues are attached

The first step is determining which tissue is responsible, because that guides treatment.

During an evaluation, I would examine your face both at rest and while you smile or clench your jaw. I would feel the thickness of the soft tissues, assess muscle activity, and compare the underlying bony contours. In some cases, imaging such as a CT scan or 3D facial photography can help distinguish whether the asymmetry is primarily skeletal or related to soft tissue.

Once the cause is identified, treatment becomes much more targeted:

If one masseter muscle is larger, Botox can gradually reduce that muscle over several months, creating a slimmer and more balanced lower face.
If one cheek is fuller because of fat, conservative fat reduction procedures may be considered, although I would be cautious with buccal fat removal. Buccal fat naturally decreases with age, and removing too much in a young person can lead to a hollow appearance later in life.
If the opposite side lacks volume, adding a small amount of filler or fat grafting to the less prominent side is often a safer and more predictable way to improve symmetry than removing tissue from the fuller side.
If the asymmetry is due to bone structure, fillers may camouflage mild differences, but they cannot change the underlying skeleton. Surgical procedures are typically reserved for more significant skeletal asymmetry that affects both appearance and function.

One principle I always keep in mind is that adding a small amount of volume is often more forgiving than permanently removing tissue. That's why I recommend being very selective about procedures like buccal fat removal or facial liposuction unless there is a clear indication.

Your goal of looking symmetrical and natural is exactly the right mindset. Rather than making both sides identical—which isn't possible or even desirable—the objective is to reduce noticeable differences while preserving your natural facial character.

Overall, I would start with a careful assessment to identify whether the asymmetry is driven by fat, muscle, bone, or a combination. Once that's clear, the treatment plan becomes much more precise, and in many cases, subtle adjustments produce the most natural-looking results.

Facial asymmetry: One cheek is fuller and hides my cheekbone and OG curve, What is the best procedure? (Photos)

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