Can conservative cheek filler help correct subtle midface asymmetry after facial trauma/surgery?

Question

Hi doctors, I’m looking for professional input regarding a subtle facial asymmetry following facial trauma and surgery. I was in an accident and underwent zygomatic surgery on the right side only in October 2024. Healing is complete, and my face feels stable. However, I’ve noticed a mild but consistent asymmetry on my right midface/cheek compared to the left side. The difference appears to be related more to contour and projection rather than overall volume or width. I’m not seeking cosmetic enhancement or added fullness. I’m only wondering whether a very conservative, deep/structural hyaluronic acid filler approach could reasonably help improve balance on the right side — or if this type of post-trauma asymmetry is typically better left untreated. My main concerns are: • avoiding facial widening or puffiness • avoiding overcorrection • ensuring any filler approach would be appropriate given prior unilateral zygomatic surgery From a facial anatomy standpoint: • Is conservative cheek filler sometimes appropriate for unilateral post-trauma asymmetry like this? • Or would observation/no treatment usually be recommended when the asymmetry is subtle? Thank you for your time and insight.

Anna Chacon, MD, FAAD · Answer

Thank you for such a thoughtful and detailed question. Subtle asymmetry after facial trauma and surgery is very common, especially after unilateral zygomatic repair, and noticing differences in contour and projection (rather than volume) is a very perceptive observation on your part.

From an anatomical and aesthetic standpoint, yes—very conservative, deep structural hyaluronic acid (HA) filler can sometimes be an appropriate way to improve unilateral midface asymmetry after trauma or surgery. When done correctly, the goal is not to add fullness, but to restore skeletal contour and projection in a controlled, structural way.

A few important considerations:

1) Conservative structural filler can be appropriate in post-trauma cases
Deep placement on the bone (supraperiosteal plane) can mimic subtle skeletal projection differences and help balance the midface. In these situations, very small amounts are typically used, often much less than what is used for cosmetic augmentation. When done conservatively, it does not have to create widening or puffiness.

2) Avoiding widening and puffiness is largely technique-dependent
Puffiness usually comes from superficial placement, excessive volume, or softer fillers placed too high in the cheek fat pads. Structural correction focuses on deep, firm fillers in micro-aliquots, which can improve contour without soft-tissue expansion.

3) Overcorrection is a real risk, but it is manageable
The safest approach is gradual correction over multiple sessions, with reassessment in between. Subtle asymmetry often looks best when corrected in stages rather than in a single treatment.

4) Prior zygomatic surgery is not automatically a contraindication
However, the injector must be very familiar with altered anatomy, potential scar tissue, and changes in vascular pathways. This is why careful technique and deep-plane placement are essential.

5) Observation is also a completely reasonable option
If the asymmetry is subtle and not bothersome in daily life, many surgeons would recommend leaving it alone. Human faces are naturally asymmetric, and post-trauma differences can sometimes be more noticeable to the person than to others.

In short, a conservative, deep structural HA filler approach can be reasonable and appropriate for subtle unilateral post-trauma asymmetry, especially when the goal is balance rather than cosmetic enhancement. At the same time, doing nothing is also a valid and often recommended choice when the difference is mild.

Your focus on avoiding widening and overcorrection is exactly the right mindset. Subtle, structural correction—or thoughtful observation—tends to produce the most natural outcomes in cases like yours.

Can conservative cheek filler help correct subtle midface asymmetry after facial trauma/surgery?

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