Facial asymmetries and what to do about them.

Thank you ever so much for this awesome site...been following for years now! My question is that I have a too large fat pad on the left side of my face pulling everything down compared to other side. Actually looks like I have a toothache swelling or a mild Bell’s Palsy. I’ve had various cheek fillers and nasal lines and marionette lines filled to help offset this. Trouble is I’m older now and it takes so much to lift my cheek it no longer looks natural. I don’t want a face lift. I’ve asked several doctors to just go inside my cheek please and lift or reduce the fat pad. No one wants to do it because they say they are more comfortable doing that during a face lift. Are there any other alternatives for me? I’m a very healthy 68 year old Caucasian woman. Thank You !

Thank you so much!! We all have facial asymmetries, so I just want to reassure you that many have similar issues. For most of us, the side that we sleep on is flatter, for example.

It sounds like you’ve had this problem for years and it’s not changing. But please everyone, if you have a sudden new or growing facial swelling or asymmetry, it’s super important that you see your primary care physician. Certain tumors can cause a change in facial symmetry.

Here are some thoughts and ideas about asymmetries:

A fat pad. First are you sure it’s a fat pad. It might be worthwhile to get an imaging study of your head to make sure. An expert with Kybella an injectible that removes fat may be helpful, depending on the location, size of the pad, and how close it is to certain nerves. This is an FDA off-label use so experts only please. Also, a talented ENT plastic surgeon may be more helpful than a plastic surgeon. ENT plastic and reconstructive surgeons work only on the head and neck, and are often more experienced with complicated anatomy.
Bell’s palsy. This is essentially an injury, often post viral or post surgical, of the facial nerve on one side. One side droops, sometimes a lot. It’s not possible to make this resolve. But by using Botox on the more active side of the face to relax it, and fillers on the droopier side, it’s often possible to make the difference between the two sides much less noticeable.
Post surgical. Post trauma or post skin cancer surgery (usually Mohs surgery) there are asymmetries created. There are many techniques now to improve scars and the pulls that result from scars with lasers, subscision, Botox/Dysport, Sculptra and fillers. These can often be improved quite easily.
Minor facial imbalances. For example, an eyebrow that consistently pops up, or one corner of the mouth that pulls down more. More balance can usually be achieved with neurorelaxers (like Botox/Dysport) or fillers.
Imbalances created by Botox/Dysport or fillers. Sadly not everyone doing this type of work is well-trained or experienced. We are seeing all around us, and even on our screens, the results. Seek a second opinion if you aren’t confident in your provider.

Hope this helps,

Dr. Brandith Irwin