How to Correct a Muscular Asymmetry of the Right Mid and Lower Face?

I'm 42 and a redhead with sensitive skin. In my 20's I had a badly absessed tooth,since removed,but ever since then the right side of my lower face has had a distinct droopiness compared to the left. I have noticed a twitch on the right when smiling sometimes. I'm curious to know what you would recommend other than temporary fillers. I don't like the idea of needing to go back for further treatments with additional expence.

Doctor Answers 9

Correct a Muscular Asymmetry of the Face?

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Thank you for your question. I recommend you see a Board Certified Plastic Surgeon, and you may be eligible for a one side facelift if the muscle and or skin is more lax on one side. If it is a volume issue, you may consider fat transfer as this can be a very long term correction. I hope this helps.

Danville Plastic Surgeon
4.9 out of 5 stars 26 reviews

Facial droopiness, facial twitching

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Assymetric facial drooping and twitching may be treated by several techniques.  

A one sided face lift ,liposuction of the jowls or augmentation of the cheeks and jawline may correct a assymetric face.

The Cellulaze, Sidelaze system can result in significant neck and lower facial tightening with minimal incisions

Botox, Dysport or Xeomin injections may correct the twitching at least temporarily.

Please consult in person with an experience Board Certified Plastic Surgeon prior to making treatment decisions.

Luis A. Cenedese, MD, FACS
New York Plastic Surgeon

Correcting Muscular Asymmetry of the Face

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This is a tough situation to evaluate by anything other than an in-person exam, in order to adequately assess the anatomical basis of
your concerns.

Jeffrey Epstein, MD, FACS
Miami Facial Plastic Surgeon
4.7 out of 5 stars 145 reviews

Cosmetic Surgery is an Art and a Science

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. It is hard to answer your question without an exam.If your asymmetry is due to a tooth extraction, then I suggest a dental implant to fill the area.Otherwise a fat fill can improve your appearance. Consult your dentist or a board certified plastic surgeon for your concerns.

Facial Asymmetry: Treating with Fillers, Fat, or Facelift

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Thank you for the interesting question. Without pictures, or an examination of your facial muscle movements, it is difficult to give exact recommendations. However, it seems that you may have two problems: 1) facial volume loss that is worse on one side; and 2) one-sided facial weakness (paresis) from nerve and/or muscle damage. These two issues would be treated in different ways. For volume loss, fat grafting or a facelift that includes a midface component (e.g., a deep plane facelift) will be helpful. For nerve weakness, a facelift may also be helpful, but other operations may be indicated as well (e.g., static sling procedures, canthoplasty, etc.). You should consult with a surgeon who has expertise in both aesthetic and reconstructive facial surgery.

Fat May Help

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Most likely fat would help as a permanent filler. Unfortunately it is difficult to be more definitive or to make other recommendations without photos.

A facelift will not correct asymmetry due to muscular or skeletal abnormalities.

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Asymmetry of the face due to skeletal asymmetry or muscular function will not be corrected by a facelift. The operation is done shallow to the structures. Almost all faces demonstrate some identifiable asymmetry.

Facial Asymmetry??

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 The droopiness as you have already stated is most likely due to a loss of volume in your face in that area. A more definitive option for you could be Fat Grafting to face to produce better symmetry.
 Loss of volume in the face is very common with aging. Restoration of this volume with Fat Grafting/ Liposuction of the face at the time of a facelift has become very common. We have several examples on our web site for your review in Photo Library 2. Consider a member of the ASAPS in your area familiar with this approach to Facial Restoration. Best,


Gary R Culbertson, MD, FACS

Gary R. Culbertson, MD
Columbia Plastic Surgeon

Treatment for facial nerve weakness

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       If you are having difficulty with smiling and you have droopiness, you may want to consider either dynamic or static slings to help support that side of your face.   A plastic surgeon can help discuss these options with you.  Sometimes Botox can be employed to help with symmetry by relaxing the stronger side, but this is a far from perfect solution.  If you just want additional volume to the area, this area could be fat grafted for a more permanent result.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.