Asymmetric / crooked face

With facial asymmetry, the two halves of the face differ. It can occur in the upper jaw (for example a tilted upper jaw) as well as in the lower jaw (for example when the lower jaw is larger on one side of the face than on the other).

In many cases, a slight facial asymmetry is barely noticeable and is often regarded as normal. On the contrary: there are studies showing that many people find slight facial asymmetries attractive. For this reason, not all patients with facial asymmetry are candidates for surgery.

However, if the asymmetry is associated with functional problems (e.g. malocclusions, jaw joint pain, headaches, bite problems, etc.) and aesthetic impairments, a consultation is advisable.

Causes of an asymmetric face

The causes of facial asymmetry can be divided into three groups:

• Genetic causes: In many cases, facial asymmetry runs in the family. But there are also other congenital anomalies, such as cleft lip, cleft palate and vascular disorders, that can cause asymmetric features.
• Acquired causes: Acquired forms of asymmetry include facial trauma, fractures, inflammation of the jaw joint, arthritis, TMJ ankylosis, facial pathologies and tumours, among others.
• Growth-related causes: Developmental asymmetries include causes such as dental treatment (especially tooth extractions, but also the use of dentures), habitually chewing on one side, constant pressure on the face from sleeping on one side only, harmful oral habits or a unilateral crossbite.

Solutions for facial asymmetry depending on its cause

The treatment of facial asymmetry aims to correct the underlying disorder. Depending on the cause, there are three classic solutions for patients:

• Dental asymmetries: If the asymmetry is due solely to poorly positioned teeth, it is treated with orthodontic treatment
• Skeletal asymmetries: If the upper or lower jaw on one side of the face is overdeveloped or not developed at all compared with the other side, the asymmetries are usually treated by combining jaw surgery with orthodontic treatment. This is called bimaxillary surgery when both the lower and upper jawbones are operated on. It is called monomaxillary surgery when the oral and maxillofacial surgeon operates on only one of the two jaws.
• General asymmetries are treated with jaw surgery accompanied by aesthetic procedures such as nose and eyelid corrections or fat grafting (autologous fat transfer).

Why treat facial asymmetry?

Improving facial asymmetry solves both aesthetic problems (such as a lack of harmony between the facial features) and functional problems (such as pain in the jaw joint or difficulty chewing), and it considerably boosts the patient's self-confidence.

How it works

1.    Initial planning

• We get to know each other during an initial consultation. We discuss your wishes and analyse which treatment options are suitable for you.
• In the next step, we take what are known as records. This includes a surgical photo analysis as well as a cephalometric X-ray and a panoramic X-ray.
• Our orthodontists then measure the data very precisely and draw up an initial plan
• We then discuss this plan together with you and decide whether purely orthodontic treatment or surgically assisted treatment makes sense.

2.    Detailed planning

• Based on a 3D scan, we create 3D-printed models of your teeth
• We then import the model data into special software and create a simulation in which we can already simulate the surgical movements
• Joint surgical and orthodontic consultation: one of the things that sets us apart is that the results of the planning are agreed together with you, an experienced oral and maxillofacial surgeon and an experienced orthodontist. This appointment is so important because the outcome of treatment ultimately depends very much on how well the medical experts coordinate. The aim is to align the treatment protocol between the oral and maxillofacial surgeon and the orthodontist. You will also be shown educational videos, and the procedure will be explained to you on a model skull.

3.    Treatment

Three treatment protocols can be considered:

• Surgery Late (long orthodontic treatment, then surgery, then orthodontic fine-tuning)
• Surgery First (surgery first, then orthodontic treatment)
• Surgery Advanced (short orthodontic treatment, then surgery, then orthodontic fine-tuning)

4.    Retention

During retention, we use state-of-the-art appliances such as Hawley retainers, Memotain wires or Vivera retainers to make sure that the result achieved also lasts. At the Eltz Institut, you also benefit from our 1-year retention guarantee.

Why the Eltz Institut

We are an international reference centre for combined orthodontic and surgical treatment (orthognathic surgery). This offers our patients the following advantages:

• Pioneers and experts in combined orthodontic and surgical treatment
• Pioneers and experts in the orthofacial approach, which looks at the face as a whole to maximise the aesthetic results
• Technology at the highest level worldwide
• Clinic awarded by Doctify for outstanding achievement in orthodontics, 2022
• Located in the centre of Vienna.

You can find more advantages here.