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Facial Asymmetry

What is Facial Asymmetry and how is it treated?

Facial asymmetry is an alteration that is defined by the presence of a disharmony between both sides of the face. That is, in the frontal vertical plane of the face, one of the two sides is unbalanced with respect to the other.

Although a mild non-pathological facial asymmetry is in many cases imperceptible and is often considered normal, its clinical importance cannot be easily determined, since facial aesthetics are completely subjective. Therefore, the degree of acceptance of this malformation will depend largely on the region of asymmetry and the perception of the patient's imbalance.

That is why not all patients who have facial asymmetry are candidates for surgery, but only those who have a degree of facial asymmetry evident for their social, professional and family environment or that disturbs their peace of mind.

PROFILE OF A FACIAL ASYMETRY PATIENT

Facial asymmetries are most commonly manifested in the lower third of the face (jaw and chin), since these bones form the skeletal support for the soft tissues of this area, in addition to having long periods of growth. The maxilla normally plays a secondary role in asymmetries, and this is attributed to the rigid fixation of this bone to the cranial base and that, having a much smaller area, it provides minimal support to soft tissues.

In patients with facial asymmetry, there are often problems of dental malocclusion, canting of the occlusal plane and  midline deviation.

Regarding the recurrence of facial asymmetry, it has been observed in different studies that patients who present a Class III skeletal malocclusion are more likely to have facial asymmetry than those who present other types of malocclusion.

CAUSES OF AN ASYMMETRIC FACE

The causes of facial asymmetry can be separated into three groups: genetic, growth-related and acquired.

  • Genetic causes: in many cases, facial asymmetry is all about family traits, but there are other congenital anomalies, such as cleft lip, palatal fissure and vascular disorders that can cause asymmetric characteristics.
  • Acquired causes: Acquired states of asymmetry include facial trauma, fractures, temporomandibular joint (TMJ) infection, arthritis, ATM ankylosis, facial pathologies and tumors, among other causes.
  • Growth-related causes: Developmental asymmetry can include causes such as dental treatment (mainly dental extractions, but also use of dentures), habitual chewing on one side, constant facial pressure during sleep exclusively on one side, oral habits harmful or unilateral cross bite.

On the other hand, sudden facial asymmetry is a sign of a more serious condition, and it can be a sign of disorders such as Bell's palsy, which causes a sudden weakening of the muscles on one side of the face. Also, facial numbness is a sign of a stroke. If your smile is suddenly uneven or you experience numbness on one side of the face, you should seek immediate medical attention.

SOLUTIONS TO FACIAL ASYMETRY ACCORDING TO ITS CAUSE

The management of facial asymmetry is aimed at correcting the underlying disorder. Thus, the three classic solutions to this problem are, according to their cause:

• Skeletal asymmetries, either in the maxillary or mandibular region (when the maxillary or mandible are developed by excess or by default on one side of the face with respect to the other side) are treated by orthognathic surgery:

  • bimaxillary, when the maxillofacial surgeon needs to surgically intervene on the mandibular and maxillary bone
  • monomaxillary, when the maxillofacial surgeon only acts on one of the two skeletal structures.

To correct the canting (one side of the bone is longer than the other) the surgeon will work to level both sides. When the problem is in the antero-posterior plane, the surgeon can move forward or backward on one side to achieve a good bone balance (mandibular centering). Depending on the case, orthognathic surgery should also be accompanied by an orthodontic treatment.

• Generalized asymmetries are treated by bimaxillary or monomaxillary orthognathic surgery accompanied by aesthetic procedures such as:

In some cases, prostheses or lipofilling techniques are also used to balance soft tissue asymmetries.

• Dental asymmetries (when the problem is due only to bad teeth placement) are treated by orthodontic treatment

WHY TREAT FACIAL ASYMETRY

The aesthetic and functional problems associated with significant facial asymmetry can very negatively affect the orofacial, nutritional and psychosocial development of the patient.

The solution of facial asymmetry, like all surgical procedures that we perform at the Maxillofacial Institute, solves at the same time aesthetic problems, such as lack of harmony in the factions, and functional, such as pain in the temporomandibular joint or discomfort when chewing , in addition to greatly improving patient self-confidence.

WHY CHOOSE THE MAXILOFACIAL INSTITUTE

When planning your surgery, our team will thoroughly analyze all the elements that make up the facial area: jaw, maxilla, maxillary buttresses, nose, teeth and all the soft tissue that covers the facial skeleton and neck region to correct the facial asymmetry and find the ideal balance of your features.

It is also important to keep in mind that a large majority of orthognathic surgery patients have some degree of facial asymmetry, which makes the medical team of the Maxillofacial Institute one of the most experienced in this area worldwide, with an average of 200 orthognathic surgery operations per year.

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