In short. The assessment in order: history and photographs, examination in movement, dental and bite evaluation, and imaging when the cause may be skeletal.
Key points
- A baseline is what makes a future comparison possible.
- Where a difference is stable and needs nothing, the photographs and measurements taken at that appointment are the reason a later change can be recognised as a change rather than debated.
- Recording is part of the assessment, not an administrative extra.
The assessment is built to answer three questions in sequence: is this outside the ordinary range, what is causing it, and is it changing. Each step rules something in or out, and the order matters because a treatment chosen before the cause is named is a guess.
The history, and the photographs you bring
When it started, whether it is changing, whether it has always been there, whether it runs in the family, and whether anything else has changed alongside it. Photographs from different years are more useful than any description, because they answer the question of change directly. The history is also where the medical questions are asked, and where a recent or progressive change is caught.
Examination at rest and in movement
The face is looked at still, then smiling, then speaking. Asymmetry present at rest has a structural cause; asymmetry that appears only in movement points at muscle pull. This distinction changes the answer entirely, and it cannot be made from a still photograph.
Measurement, and the record
Positions are measured and written down rather than estimated: the level of the eyes, the position of the jaw and the chin, the outline of the cheekbones, and the line between the centres of the face. Numbers matter because progression can only be answered by comparing measurements taken at different times.
Why the record is kept even when nothing is treated
A baseline is what makes a future comparison possible. Where a difference is stable and needs nothing, the photographs and measurements taken at that appointment are the reason a later change can be recognised as a change rather than debated. Recording is part of the assessment, not an administrative extra.
The bite, and the dental opinion
How the teeth meet, whether the jaw deviates as it closes, and whether teeth are missing or worn unevenly. Where the bite contributes, the assessment includes a dentist, because correcting the soft tissue while leaving the bite produces a face that returns to its old pattern. This step is the one most often skipped and most likely to change the plan.
Imaging, when the cause may be skeletal or medical
Where the cause appears to be bone, or where a medical cause is possible, imaging is arranged. It answers questions that examination cannot: the position of structures that cannot be felt, the shape of the jaw joint, and whether a difference in the bones is present. It is ordered for a reason, not routinely.
Findings that change the assessment
- A difference that measurement shows to be increasing rather than stable.
- Weakness, numbness, or a bite that has changed since a previous record.
- A lump, jaw pain, or an eye that no longer closes completely.
What the four causes are, and how each reads on the face, is set out in bone, muscle, fat or dental. Whether what you have falls inside the ordinary range is covered in the normal range, and the rungs that follow the assessment are walked through in the ladder, rung by rung.
Frequently asked questions
Why is the face examined while it moves?
Because some asymmetry is only present in movement and some is only present at rest, and the two point in different directions. A difference that appears when the face smiles points at muscle pull; one that is present when the face is still points at structure. A still photograph cannot make that distinction at all, which is why the examination watches the face do something.
What does the dentist contribute that a surgeon cannot?
The bite, and the way the jaw moves as it closes. Where the teeth are worn unevenly, where a tooth is missing, or where the jaw deviates as it meets, the soft tissue is being guided by the teeth, and correcting the face without correcting that produces a result that drifts back. The dental assessment is what rules the bite in or out.
When is imaging needed?
Where the cause appears to be skeletal, or where a medical cause is possible. It is not ordered for every uneven face, because most asymmetry is a soft-tissue variation that does not need it. Where the history or the examination raises a specific question about bone or about a structure that cannot be felt, imaging is what answers it.
Risks & Limitations
- Correcting a difference that sits inside the ordinary range creates a visible change in a face that read as even to everyone who saw it.
- Bone surgery, and jaw surgery combined with orthodontics, are substantially larger undertakings than soft-tissue treatment, with a longer recovery.
- Filler placed over a difference determined by bone adds weight without changing the shape that produced the asymmetry.
- No option makes the two halves identical, and the face continues to change on both sides afterwards.
When to Seek Care
- A difference that has appeared over days or weeks, or that is measurably increasing.
- Weakness on one side of the face, numbness, drooling, or a change in speech — seek urgent care.
- A new lump in the face or jaw, or a bite that no longer meets as it did.
- Difficulty closing an eye, or eye pain and light sensitivity.
References & Further Reading
- American Society of Plastic Surgeons (ASPS) — procedure and safety guidance
- National Institute for Health and Care Excellence (NICE, UK) — relevant guidance
- Cochrane Library — systematic reviews
- Chinese Medical Association Plastic Surgery Branch — clinical guidance
This page is patient education, not medical advice, and it does not cite individual studies. Discuss your own case with a qualified clinician. To arrange an assessment at Chongqing West District Hospital, see Contact & Consultation.