Is there a way to fix a noticeable facial asymmetry on my left?

Hello Dr. Irwin I LOVE your site! With that said, I've taken the time to go through quite a bit of your blog to get my question answered and still cant quite pin down what I'm looking for. So here is a bit about me and my question will follow. I just turned 40. The left side of my face is significantly more lax in skin texture (very visible) than my right. The other problem is I have significantly more pronounced crows feet/lines under the left side of my eye opposed to the right as well. I'm hoping to get the left side to match the age on my least the best I can. I HAVE started botox for all my problem areas. Great stuff. I've read great things about your thermage treatments and the tightening effects on the skin. I've also read great things on your DOT laser experience and results as well. My question is which one would you suggest to get the skin tightening results I so desperately want and also treat the pronounced crows feet? Thank you!

Thank you!   It would be interesting to have you look back at photos when you were 16-25.  Can you see the asymmetry even back then or younger?  Some people have an inborn (genetic) assymmetry and if you look back it’s there very early, just more subtle.   Other people have an external cause like they sleep on the same side all the time (that side will usually have less volume), or they had a Bell’s palsy, etc.

To correct this, it’s usually best to fix the underlying volume deficit first, for example with Juvederm/Restylane or Sculptra.  Once the volume is as close to symmetric as possible on both sides, then tighten the skin over that more supportive volume.  If it’s just a little and the skin is smooth, Thermage would be a good choice at your age (40).  If the skin has wrinkles or the skin is still pretty loose, then a fractional CO2 laser like the DEKA will usually be more effective.   Hope this helps,  Dr. I


Dr. Brandith Irwin, MD

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