My left cheek looks totally different than my right cheek and it really bothers me, how can this be treated? (photo)

Question

Is it a bone problem or a fat problem? I am currently now at BMI 27 and I am planning to lose more weight, will this solve the problem?

Jason Emer, MD · Answer

Losing weight won't necessarily improve an asymmetry. We all have some facial asymmetries, but well-placed fillers (Voluma, Radiesse, Bellafill) and Sculptra, can improve facial balance and symmetry. Fat or implants are alternatives. I recommend getting a formal evaluation with a facial sculpting expert. Best, Dr. Emer

Amiya Prasad, MD · Answer

Thank you for your question. You submitted a single photo, and state your left cheek is completely different from your right cheek, so you’re wondering whether it is the bone, fat, or both contributing to this appearance. You also mention you are planning to lose more weight, and want to know how to fix this problem.
I can discuss this question with you based on the type of approach I have in my practice for similar situations. A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I’ve been in practice in Manhattan and Long Island for over 20 years, and this concern about symmetry is pretty much shared by every patient to some degree, whether they are interested in eyelid surgery, facelift surgery, injectable fillers or anything else. They are always aware there is a difference between one side and the other. They can’t always understand exactly what, but they recognize there is asymmetry.
What is the basis for asymmetry? One is the fact that most people are genetically asymmetric to some degree. Some people are more asymmetric than others, but basically when you think about one side of the face from the other side, there is a relative microsomia or just a little less projection of the bone structure on one side compared to the other. It’s very common to have one cheekbone more prominent than the other or the projection forward being different from one side than the other. Basically the foundation is the bone structure, above it are the muscles, fat, skin, and soft tissue. 
In a situation like yours, understanding you are planning to lose more weight, there is a high likelihood that there will be a change in the relative volume of cheek material or mass on the right side. You may get some degree of relative symmetry because the right cheek looks a little more full than the left cheek. Very often, when people are losing weight, as long as they are within 5-10 pounds of their ideal body weight, they can hold the weight steady for a long time, unless they are an athlete who does things like marathons, triathlons, or someone who burns a lot of fat, or has a very low percentage of body fat. Most people with regular work and lives and relatively good diets usually float somewhere around 5-10 pounds of their ideal body weight if they are into fitness. That said, usually there is some degree of fat in their face, which is normal.
When trying to balance things out, we usually do some variation of fillers that can be placed at different levels in the face. One area we really find very helpful is a technique called structural volumizing where we are placing a thicker filler like Juvederm Ultra Plus or Juvederm Voluma® at the level of the bone. We are able to place it under the muscle and restore or augment the volume at the bone level, which means to a degree, we can compensate some of that asymmetry where there is a relative deficit on one side compared to the other. We can also place the volume in the soft tissue, but as a general rule of thumb, for the cheek, I try to do more at the structural level because it is more stable, and the muscles and soft tissue glide over that material. When placing it in the soft tissue, the volume has to be limited to a certain amount before it creates a weight, or pushes down or spreads out, or may look a little irregular.
There is an art to the placement and choosing the type of filler. We are actually living in a very good time in the world of fillers because hyaluronic acid fillers, whether it is in the Galderma/Restylane family, or the Allergan/Juvederm products, we have a lot of options from different viscosities, particular properties, and different ways to apply these fillers, so we have a lot of flexibility, but they require an understanding of the art of placement. Every day in our practice people come in, we discuss fillers, and they always talk about how they don’t want to look like a certain person because they don’t want to look ballooned or unnatural. I also point out is that what they don’t know is people look good with fillers because they look very natural, so again it is about the art of placement the art of understanding the proportions. The Golden Ratio is a natural balance to the face where you want to maximize an attractive look regardless of ethnicity, which is remarkable - the Golden Ratio is almost universal.
I think it make sense for you to meet with qualified, experienced doctors who do a lot of these fillers, who you feel are able to understand your concerns, and see what strategy would work best for you. It is very important you get comfortable with one doctor who you feel really gets what you want, and is able to achieve it. In my practice, I spend a lot of time with every patient. I take their pictures, put them up on the screen, look at them very critically, and we look together to plan things out. I treat fillers pretty much the way I treat surgery, so it’s about really good planning, markings, placement, then achieving the optimal balance. We follow them up in 2 weeks to make sure everything looks good, or if an area needs to be tweaked, we do it.
Agan, meet with qualified, experience physicians who do a lot of fillers. Discuss your weight loss plan and see how that fits in the context of your concerns, and move forward. I hope that was helpful, I wish you the best of luck, and thank you for your question.This personalized video answer to your question is posted on RealSelf and on YouTube. To provide you with a personal and expert response, we use the image(s) you submitted on RealSelf in the video, but with respect to your privacy, we only show the body feature in question so you are not personally identifiable. If you prefer not to have your video question visible on YouTube, please contact us.

My left cheek looks totally different than my right cheek and it really bothers me, how can this be treated? (photo)

Answers (2)

Recommended reading

Everything you need to know about Cheek Augmentation

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

My left cheek looks totally different than my right cheek and it really bothers me, how can this be treated? (photo)

Answers (2)

Browse related questions

Recommended reading

Everything you need to know about Cheek Augmentation

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