Facial Asymmetry in Barcelona
What Is Facial Asymmetry?
No one is perfectly symmetrical. If we conduct a detailed facial analysis, we’ll see that asymmetries exist in everyone—whether in the placement of the ears, the position of the eye sockets, the chin, or the midline.
There are very obvious asymmetries that make our face look unnatural and require correction. This correction is performed through orthognathic surgery or, in mild cases, through surgical camouflage.
Orthognathic Surgery
Correction through orthognathic surgery typically involves bimaxillary surgery, aligning the mandible and maxilla in all three spatial dimensions and across all three spatial planes. We will align the facial midline with the dental midline, level the maxilla and mandible (correction of canting), and adjust the occlusal plane. Finally, we will assess asymmetries of the chin and correct them through mentoplasty.
In this type of orthognathic surgery to correct asymmetries, we always perform virtual surgical planning, which allows us to determine the ideal position of the jaws with a high degree of precision. This virtual planning will be reproduced intraoperatively using the CAD/CAM surgical guides that we have printed, in which the teeth occlude correctly only if we have perfectly replicated the previously planned movements.
Surgical Camouflage
This allows us to identify skeletal differences in the jaw or cheekbones, and this difference in volume results in a customized facial implant that will be placed intraorally under local anesthesia and sedation. It is a minimally invasive procedure with a quick postoperative recovery.
Frequently Asked Questions
How do I know if my facial asymmetry requires surgery, or if I can leave it as is?
Minor asymmetries are completely normal: virtually no one has a perfectly symmetrical face, and in many cases, those differences are part of what gives the face its character. The decision to treat an asymmetry depends on three factors: whether it causes you aesthetic or emotional distress that affects your daily life, whether it causes functional problems (difficulty chewing, breathing problems, pain in the temporomandibular joint), and whether it is progressive (it worsens over time, for example, in some active condylar hyperplasias). At Clínica Birbe, we perform a comprehensive initial evaluation that includes a facial analysis, clinical photographs, and a facial scan to determine the cause of your asymmetry and recommend only the treatment you truly need—ranging from minimally invasive camouflage to orthognathic surgery, depending on each individual case.
How is the cause of facial asymmetry diagnosed?
Diagnosis is the most important phase because it determines whether the asymmetry is due to bony causes (lower jaw, upper jaw, chin, or cheekbones), dental causes (crossbite, tilted occlusal plane), muscular causes, or soft-tissue causes (asymmetry in fat, skin, or scars). At Clínica Birbe, we combine four tools: a three-dimensional clinical facial analysis performed by Dr. Joan Birbe, an ABOMS-certified specialist; a standardized photographic study; a digital facial scan; and CBCT (3D tomography) to evaluate bone structure with millimeter precision. Using that data, we create a virtual simulation that shows exactly which structure is displaced and by how much, before recommending any treatment. This approach avoids unnecessary procedures and allows for highly reliable predictions of the aesthetic and functional outcome.
At what age can facial asymmetry be treated surgically?
The minimum age depends on the type of asymmetry and whether facial growth has been completed. In women, bone growth is usually complete by age 17–18, while in men it can continue until age 20–21. Having surgery too early can compromise the outcome because the bone is still developing. There are important exceptions: in cases of active condylar hyperplasia (uneven and progressive growth of a mandibular condyle), it may be necessary to intervene earlier to slow the progression of asymmetry, as is the case with some congenital malformations. On the other hand, there is no upper age limit: we perform facial asymmetry surgery on adult patients of any age, provided their overall health permits it. During the initial assessment, we determine the optimal timing for your specific case.
Are there non-surgical alternatives for correcting mild facial asymmetry?
Yes, although the results are limited and do not replace surgery when the asymmetry is bony. For mild soft-tissue asymmetries, aesthetic medicine options may be considered, such as hyaluronic acid fillers (temporary effect lasting 9–18 months), botulinum toxin to rebalance facial muscles (effect lasting 4–6 months), or lipofilling (filling with the patient’s own fat, which is more long-lasting). These alternatives are useful for cosmetic touch-ups, but if the problem is skeletal in origin—such as a displaced lower or upper jaw, bone tilt, or an asymmetrical chin—only orthognathic surgery or surgical camouflage using custom facial implants can provide a long-lasting result. At Clínica Birbe, we clearly explain the actual scope of each option so that you can make an informed decision based on your expectations and the nature of your asymmetry.
Are the results of facial asymmetry surgery permanent?
Yes, when the surgery is performed after facial growth is complete and with rigorous virtual planning, the results are stable in the long term. Bone fixation is performed using biocompatible titanium miniplates and screws that hold the bones in their new position until they heal (between 3 and 6 months), and the custom facial implants used in surgical camouflage are designed to integrate permanently. There are two factors that can affect how the results are perceived over the years: the natural aging of the soft tissues (skin, fat) that occurs in any face, and changes in the teeth if the recommended orthodontic treatment is not maintained. That is why at Clínica Birbe we plan each case using Dr. Joan Birbe’s (ABOMS) CAD-CAM surgical guide to ensure that the procedure is performed exactly as planned, and we establish a postoperative follow-up plan that ensures the stability of the results over time.
Dr. Joan Birbe: ABOMS certified specialist
Dr. Joan Birbe is the only maxillofacial surgeon in Spain certified by the American Board of Oral and Maxillofacial Surgery (ABOMS), the most rigorous international certification in oral and maxillofacial surgery. It is a renewable certification, based on continuing education, case evaluations, and review of results, which sets a standard well above what is typical in Europe.
In the treatment of facial asymmetry, this requirement translates into one crucial factor: three-dimensional precision. Correcting asymmetry is not simply a matter of shifting the jaw to one side: it involves leveling the occlusal plane, deciding whether to combine mentoplasty with lateral displacement, planning differential movements in each hemiarch, and, in many cases, incorporating bone grafts or custom facial implants to equalize volumes. It is one of the types of orthognathic surgery with the highest risk of “overcorrection” or “undercorrection” if the planning is not precise down to the millimeter.
Dr. Birbe addresses each case of asymmetry using his own 3D virtual planning and preoperative surgical simulation, drawing on more than 20 years of experience treating these types of cases in Barcelona, including severe asymmetries associated with condylar hyperplasia, sequelae of facial trauma, or congenital malformations. It also involves coordination with orthodontics and, when necessary, with TMJ surgery, because treating asymmetry without taking the joint into account is one of the most common causes of poor outcomes in the medium term.
When a patient with facial asymmetry comes to Clínica Birbe, they do not receive a “protocol”: they receive an ABOMS evaluation, personalized treatment planning, and a plan designed to achieve true symmetry—not just apparent symmetry.
Why Choose Clínica Birbe for Surgery?
Facial asymmetry is probably the type of case that poses the greatest challenge for a maxillofacial surgeon. Every asymmetrical face is unique—no two patients have the same combination of mandibular deviation, occlusal plane inclination, difference in ramus height, or dental compensations—and for that reason, it cannot be treated using standard protocols. The planning must be completely customized, down to the millimeter, in all three dimensions.
At Clínica Birbe in Barcelona, we have made facial asymmetry one of our areas of greatest expertise. We routinely use 3D virtual planning based on CBCT scans, intraoral scans, and clinical photographs to simulate the outcome before entering the operating room and to design custom surgical guides (or, in select cases, custom-made plates using CAD/CAM technology). This drastically reduces the margin of error in the operating room and, above all, allows the patient to see what their face will look like after the correction before deciding to undergo surgery.
The multidisciplinary team is another key factor: a maxillofacial surgeon, an orthodontist, and—when the case calls for it—a TMJ specialist all work together on the same treatment plan from the very first visit. Many asymmetries are accompanied by joint abnormalities (clicking, pain, locking) that, if not properly evaluated and treated, may worsen after surgery.
And, as with all treatments at our clinic, we provide a fixed-price quote after the evaluation, financing options, and honest diagnosis: if the asymmetry is mild and can be corrected with orthodontics or less invasive cosmetic treatments, we’ll let you know. If you need surgery, we’ll explain exactly what will be corrected and what realistic results you can expect.
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