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Asymmetry of the face and skull is often stated to be the ‘norm’. In fact, many plastic surgeons say that not only is facial asymmetry common it also adds character and uniqueness to those who have it. When face or skull asymmetry exists it commonly occur together as the crania facial skeleton develops in an interconnected fashion.

In the October 2019 issue of the journal Aesthetic Plastic Surgery an article was published entitled ‘Anthropometric Analysis of the Human Skull for Developmental Left-Sided Asymmetry, New Finding’. In this paper the authors analyzed forty-one (41) skulls using pictures of their front, lateral, and top views. Measurements were taken for exact comparison of fixed-point distances on the skulls.

Comparison of right and left measurements on the skulls revealed several fixed asymmetries. The most significant differences were seen around the orbit. The distance between the upper orbit point and zygion (zy), zygion to sub-nasal, and orbital areas were significantly larger on the left side. Measuring the anterior gonion–pogonion distance showed a wider mandibular body on the left side. No other differences between any other left-sided and right-sided skull measurements were seen.

While asymmetry of the face and many other body areas occurs in human anatomy, this paper describes for the first time consistent asymmetries between the right and left sides. They came to this initial observation based on years of doing facial injectable fillers and facelift surgeries where the right side of the face required more injectable volumes and had more loose skin. Their findings showed that the orbit was significantly bigger in width, height, and surface area on the left side and a narrower mandible on the right side.

In looking at thousands of 3D skull and facial CT scans in the designing of custom implants, many of which involve asymmetries, I will say that I more commonly see right orbits that are smaller/lower and lower jaws that have a less wide and lower angles and jawline. Such observations occur less frequently in reverse (e.g., lower left orbit and smaller/lower left jaw angle/jawline) but they do occur. It is also much more common to see a right flat back of the head than that of the left side..

Dr. Barry Eppley

Indianapolis, Indiana

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