How Can I Fix My Ear and Facial Asymmetries?

Q: Dr. Eppley, I am writing this email to share my concerns about a craniofacial asymmetry that has been bothering me. I was born as a preterm baby and I was hospitalised for over two months due to low birth weight and complications from hydrocephaly. Since my childhood, I have been extremely conscious about my prominent ears. I also had dental malocclusion, which bothered me as I believed that it contributed to my lopsided smile but otherwise, there were no complications in speech or eating. In 2011, I underwent orthodontic treatment and in 2013, I had otoplasty to correct my prominent ears. While the otoplasty dramatically improved my appearance, I noticed that my left ear was slanted at an angle “\” while my right ear seemed perfect. I underwent two revision otoplasty till 2014 to unsuccessfully resolve this issue. I then decided to let the matter rest.

My first orthodontic treatment concluded in 2014, by my lopsided smile remained and I am still undergoing orthodontic treatment to this date to correct a mild occlusal cant. I have had consultations with oral and maxillofacial surgeons in 2016 and they ruled out jaw asymmetry.

I have spent the past decade trying to understand the factors contributing to my facial asymmetry. The issue that bugs me the most to date is my lopsided left ear.

I used to go to a hairdresser regularly, who pointed out that my head is asymmetrical – my left side is convex, and the back was apparently “flatter”. Frankly speaking, I have never noticed the latter. I started reading up on cranial asymmetry and I eventually realized that the issues I have are most likely linked to plagiocephaly.

It seems like a hopeless cause, and I am not sure if anything can be done to correct my facial asymmetry. I hope something can be done to bring some harmony between the left and right ear and correct my lopsided smile.

A: In answer to your ear and facial asymmetry questions:

1) You have correctly surmised that changing the position of the ears vertically is not possible as your two previous attempts to do so have failed. Thus leaving them alone is the appropriate choice.

2) Conversely the skull and facial asymmetries are very improvable as your 3D CT scan shows the bony asymmetries of the right back of the head and the left cheek and jawline for which custom implant designs treat those very effectively.

3) The lopsided smile (one mouth corner higher than the other) is challenging since there is no good way to lower the higher left mouth corner side.

Dr. Barry Eppley

World-Renowned Plastic Surgeon