In short. Some asymmetry was always there; some an operation can introduce. How both are documented beforehand, and why the frontal view is what judges it.

Key points

  • A difference between the two sides is easier to see when the face is inverted, because the brain stops reading it as a face and starts reading it as a shape.
  • Turn a frontal photograph through one hundred and eighty degrees and look at where the two cheekbones sit relative to each other.
  • Most people who do this find a difference they had never noticed.

Asymmetry is this site's central risk in plain terms, and it has two sources that are often discussed as one. Some of it was there before the operation and becomes easier to see afterwards, and some of it the operation itself can introduce. Both are managed by measuring the two sides before anything is done.

The asymmetry that was already there

The two sides of a face are rarely equal. One cheekbone is commonly more prominent, one arch sits further forward, and the difference is invisible to the person who has lived with it. It becomes visible when something changes, which is why patients frequently report asymmetry after an operation that did not create it. Imaging measures each side separately, and a plan that reduces both by the same amount can remove the same prominence from two structures that were never equal.

The asymmetry an operation can introduce

There are several routes. The two sides may heal differently, with one retaining more swelling for longer. The amount of bone moved on each side is a decision made separately, and if the two are treated as one measurement the result follows. And the soft tissue over the two sides may settle differently. None of these is a mistake in the ordinary sense, which is why the subject is raised in advance.

Look at your frontal photograph upside down

A difference between the two sides is easier to see when the face is inverted, because the brain stops reading it as a face and starts reading it as a shape. Turn a frontal photograph through one hundred and eighty degrees and look at where the two cheekbones sit relative to each other. Most people who do this find a difference they had never noticed.

How both are documented beforehand

By measuring each side rather than only the whole face. Imaging establishes the position and thickness of each cheekbone and arch separately, which is what allows a plan to reduce one side differently from the other where that is what the anatomy calls for. Clinical photographs taken in the frontal and oblique views before the operation are part of the record.

Why the frontal view judges it

Because that is the view in which a difference between the two sides is visible. A profile view superimposes the two halves and hides exactly the finding in question. The judgement is made once the swelling has fallen and the soft tissue has settled, and the comparison is made against the photographs taken before the operation rather than against memory. A patient who knows what her face was doing before the operation can judge what it did.

What to establish before the operation

  • Whether the two cheekbones and arches differ, and by how much, measured separately.
  • Whether the plan reduces each side by the same amount or a different amount, and why.
  • Which view will be used to judge the result, and at what point after the operation.

Related reading

Frequently asked questions

Is my face supposed to be symmetrical?

No. Every face differs between the two sides, in the cheekbone as much as anywhere, and the difference is usually invisible to the person who has it until it is pointed out. What matters is not whether a difference exists but whether it is large enough to be seen, and whether a plan that reduces both sides equally would make it more visible rather than less.

Can the operation make asymmetry worse?

It can make a difference that was already present more visible, because reducing both sides by the same amount removes the same prominence from two structures that did not start equal. It can also introduce a difference through how the two sides heal. Both are reasons the two sides are measured separately from imaging.

When is asymmetry judged after surgery?

Not in the first weeks. Swelling resolves at different rates on the two sides, so almost every face looks uneven at two to three weeks and many look uneven at three months. The frontal view is assessed once the soft tissue has settled over the new contour, which is usually somewhere between four and six months, and a difference that remains at that point is a real finding.

Risks & Limitations

  • The change to the bone is permanent. Bone that has been cut away cannot be restored as it was, so the amount removed is decided from imaging and treated as fixed once it has been set.
  • The cheekbone is a support. Removing part of it removes part of what holds the midface up, so hollowing in the temple or the cheek is a property of the operation rather than a complication of it, and it is discussed before surgery rather than after it.
  • The zygomatic branch of the facial nerve crosses the region the operation works in. Weakness around the eye or the smile after surgery is usually temporary and usually resolves over weeks to months; a lasting weakness is uncommon but possible.
  • Swelling hides the width for months. The face reads unevenly at two to three weeks, is not close to final until four to six months, and is judged honestly between six and twelve months.
  • Numbness of the cheek and the upper lip is expected after this operation, is watched rather than treated in the early weeks, and may not return fully in some areas.
  • The two sides of a face are rarely identical, and reducing both by the same amount can make a difference that was always present more visible rather than less.
  • The operation changes the width at the level of the eyes and the outline behind the cheek. It does not narrow the lower face, change the bite, lift the soft tissue, or alter the skin.

When to Seek Care

  • Swelling that is increasing rather than settling after the first week, or that is much greater on one side — contact the team.
  • A wound that is opening, or discharge, spreading redness or warmth around an incision.
  • A weakness around the eye or the smile that is worsening rather than improving, or an eye that will not close — seek emergency care at once.
  • Fever, or feeling generally very unwell with a wound or a swollen area.
  • Calf pain, swelling or tenderness in one leg, or shortness of breath or chest pain — seek emergency care at once.

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

Medically reviewed by Tongchun Mao, MD (毛彤春), Deputy Director & Head of Aesthetic Surgery. Last reviewed: 19 September 2026.

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.