Facial asymmetry, age 33. Looking for a more permanent solution. (photo)

Question

I’m a 33 year old female, and I have a lot of asymmetry on my face. It’s almost as if my the right side of my face and eye is deeper set or smaller than my left. I first noticed it in my 20s, and I feel like it’s been getting progressively worse with age where I now feel fatigue and tenseness. I tried Botox once before and while it definitely helped raise my right eyebrow, my facial features still appeared pushed back. I am looking for a more permanent solution. Is this just cosmetic?

Kenneth D. Steinsapir, MD · Answer

Because people sometimes post pictures reversed, I can't tell if this is your right or left side. On the side with the higher eyebrow, you have and innie eyelid. In contrast the other side with the lower eyebrow, you have an outie eyelid. This is the basis of a lot of your facial asymmetry. It is not fixed with fillers or botox. The cause of the compensatory high eyebrow is going on inside the innie eyelid. You have a central levator partial disinsertion. You able to compensate for this by hiking up the eyebrow, something the brain does without your awareness. This requires upper eyelid surgery to address this. The slippage in the eyelid needs to be repaired. This often successfully repairs the situation and allows the eyebrow to relax down. I also wonder if you have retained filler in your cheeks. If you do, I might also recommend removing this filler. There is not substitute for an in person consultation.

Gary M. Horndeski, MD · Answer

You have a very high vertical forehead with a high hairline.  You would benefit from a brow lift done at the hairline junction.  This will decrease the vertical height of the forehead, lower your hairline and correct the asymmetry of your eyebrows.

Best Wishes,

Gary Horndeski, M.D.

Leyla Arvas, MD · Answer

As a plastic surgeon, I understand how facial asymmetry can affect both your appearance and your confidence. Based on your description, it seems like you’re dealing with a combination of structural asymmetry and age-related changes, which can make the imbalance more noticeable over time. The fatigue and tenseness you’re experiencing could also be related to muscle tension or compensatory mechanisms due to the asymmetry.
I recommend brow lift or forehead lift, would be an excellent option to address the asymmetry in your upper face, particularly if your right eyebrow and eye area appear deeper set or smaller. This procedure can elevate the brow, smooth out the forehead, and create a more balanced and youthful appearance. It can also help alleviate the tension or heaviness you’re feeling in the area.Also, your forehead is wide, which can contribute to the overall imbalance in your facial proportions. A forehead reduction surgery (also known as hairline lowering surgery) could be a great option to reduce the height of your forehead and create a more harmonious facial balance. This procedure involves removing a strip of skin at the hairline and bringing it down to achieve a more proportionate appearance.
Since Botox helped raise your right eyebrow but didn’t fully address the “pushed back” appearance, it’s possible that you may benefit from additional procedures to achieve optimal symmetry. For example:
Fat Grafting or Dermal Fillers can add volume to the deeper-set areas of your face, restoring balance and contour. To determine the best course of action, I would recommend a thorough in-person evaluation. 
While some of your concerns may be cosmetic, the fatigue and tenseness you’re experiencing suggest there may be functional aspects to address as well. A brow lift or forehead lift, combined with a forehead reduction, could provide both aesthetic and functional benefits. However, it’s important to tailor the treatment plan to your unique anatomy and goals.

Zoran Potparic, MD · Answer

Asymmetry of the face is present on every face but it is more noticeable in some faces. Use of make up. Botox, fillers, fat grafts may improve this condition. In person or a teleconference consultation with a board certified plastic surgeon with good reputation in facial rejuvenation is recommended. Good luck.

Facial asymmetry, age 33. Looking for a more permanent solution. (photo)

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Answer: Facial asymmetry

Answer: Facial asymmetry

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Facial asymmetry, age 33. Looking for a more permanent solution. (photo)

Answers (4)

Answer: Facial asymmetry

Answer: Facial asymmetry

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Recommended reading

Everything you need to know about Eyelid Surgery

Our mission is to create a world where every investment in modern beauty is Worth It.