Rhinoplasty Operation and Facial Asymmetry

Facial bone asymmetries are very common in patients looking for nose aesthetic procedures!

Facial Asymmetry in Rhinoplasty

Many patients who are looking for nasal aesthetics also have asymmetry in the facial bones. In fact, many people have more or less asymmetry in the facial bones. Published on this subject, in a scientific study published by Dr. Carvalho et al., It was emphasized that a greater percentage of patients considered themselves asymmetric than volunteers (study link >> Rhinoplasty and facial asymmetry: Analysis of subjective and anthropometric factors in the Caucasian nose).

It was emphasized that none of the patients included in the study had complete symmetry. So everyone has more or less facial asymmetry! However, in patients scheduled for rhinoplasty operation, patients should be informed about facial asymmetry before the operation, and it may not be sufficient to achieve full symmetry on the face with only a nasal aesthetic operation; It should be emphasized that in patients with severe facial asymmetry, a full symmetrical nose cannot be obtained with a rhinoplasty operation. As seen in the photo above; in a patient with severe cranial asymmetry and nasal asymmetry, it should be shared with the patient that both walls of the nose are of different lengths (such as both facial halves) and that this asynmetry cannot be completely eliminated by a nasal aesthetic operation. It looks as if the facial halves of two separate people are joined together! The information highlighted here is very important. In the noses that are already very asymmetrical, the possibility of facial asymmetry is very high.

What causes an asymmetric face?

The factors that can cause facial asymmetry are summarized below:

• Genetic reasons

Facial asymmetry can be common in the family. Apart from this, asymmetrical face may also occur in various vascular diseases that cause changes in cleft palate, cleft lip and facial structure.

• Smoking

Exposure to cigarette smoke may affect the skin and subcutaneous face, causing an asymmetrical appearance.

• Tooth and jaw problems

Various dental problems and jaw joint problems, structural changes in the jawbone (due to accidents) can cause an asymmetrical face.

• Aging

Over the years, tissue aging and asymmetrical appearance may occur asymmetrically on the face.

• Face and head injuries

Especially after childhood traumas, more pronounced facial asymmetries may occur over time.

• Facial paralysis
• Stroke
• Tortikollis (source links >> Asymmetrical Face: What Is It, and Should You Be Concerned?) 

Dr. Yao et al. In a scientific article published by, it was emphasized that surgeons should be careful about midfacial asymmetry in patients seeking rhinoplasty operation for the treatment of crooked, twisted or deviated nose (aerticle link >> https://jamanetwork.com/data/Journals/FACI/5666/ qoa80027_157_164.pdf). It is important for surgeons to emphasize that not all asymmetries can be eliminated with rhinoplasty operation, in order to have a realistic expectation in patients, that the effect of "facial asymmetry on nasal deviation or the nasal axis" is very important. Correction of congenital or traumatically deviated noses requires a different and often more surgical plan. It may need to be done more aggressively than for standard aesthetic rhinoplasty. Depending on the amount of facial asymmetry present, the surgical procedure may become more difficult and more complex.

The risks of photo animation programs!

Some patients with severe facial asymmetry and nasal asymmetry report that they achieve full symmetry in their face and noses by shaping the skull with simple digital photo animation programs (you did not read it wrong, as if by cross-pressing). Here, it would be a big mistake to keep the surgical procedure the same as a simple digital processing program. Reshaping a person's facial bones and even achieving full symmetry again by breaking the skull that protects the brain is a distant expectation in science. Before waking up from a dream and experiencing serious disappointment, trust a physician who examines you and reveals realistic information.

Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul

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