Lopsided Face: Causes and Treatment

Bell's palsy is the most common cause

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Most people have some slight unevenness of their face that is barely noticeable. But an obviously lopsided face, a new change in your facial appearance, or weakness of your facial movements can be a sign of a medical problem.

There are many possible reasons for a lopsided face, and a sudden change in symmetry could be a sign of a serious condition. It’s important to get medical attention right away for any change in facial appearance or movement because some causes, like a stroke, can be dangerous. Outcomes are likely to be better if treatment is initiated as soon as possible.

This article will discuss the causes of a lopsided face, when to see a healthcare provider, how a diagnosis is made, and treatment options.

Man checking for lopsided face in mirror

Stígur Már Karlsson / Heimsmyndir / Getty Images

Lopsided Face Causes

The causes of an uneven appearance of the face are very different from each other, and may be associated with problems involving teeth, muscles, the facial nerve, the brain, and more. 

Bell’s Palsy

Bell’s palsy is the most common cause of a lopsided appearance of the face. This occurs due to diminished function of the facial nerve on one side. It causes severe inability to move one side of the face, including the forehead.

This condition may be associated with inflammation of the nerve, and it improves within a few months, typically without causing any long-term harm. 

Stroke

A stroke is a serious condition that occurs when blood supply to a region of the brain is interrupted. Symptoms develop because the area of the brain that’s deprived of blood is permanently damaged. A lopsided face is one of the effects of a stroke.

Torticollis 

Torticollis is a muscle spasm of the neck that causes long-term tilting of the neck, often with a lopsided face as well. It can occur due to a birth defect, nerve damage, or muscle damage. Sometimes torticollis is part of a movement disorder. 

Injury

Traumatic damage to the face or mouth can cause a lopsided appearance of the face. The immediate effects may appear very uneven if an injury causes a lot of swelling. As swelling resolves, the face may look different. Treatment, such as surgery, may be necessary.

Dental Problems 

Sometimes dental problems, like an infection, can cause swelling, which may appear as a lopsided face. Additionally, having many teeth pulled can cause the face to be uneven.

Other

Cancer can grow into the face or the mouth or around the facial nerve branches that control facial movement. This can cause asymmetry of the face. 

Sometimes a dental procedure or a procedure involving the face can damage a nerve and cause facial asymmetry. This is a risk especially if surgery is done to remove a tumor that has grown into a branch of the facial nerve.   

When to See a Healthcare Provider

If you have noticed that your face seems swollen, or if there is a mild or subtle change in your facial appearance, make an appointment to see a healthcare provider. 

You need to get prompt medical attention if you experience a new or sudden change in the appearance of your face, an inability to move your face the way you normally do, or pain, redness, a fever, or significant swelling of your face or mouth. 

If You Think Someone Is Having a Stroke

Get immediate medical attention if you or someone else is having symptoms of a stroke.

Stroke symptoms include any of the following:

  • Weakness or sensory changes on one side of the face 
  • Weakness or sensory changes on one side of the body 
  • Double vision, blurred vision, or vision loss 
  • Slurred speech 
  • Difficulty communicating or understanding language
  • Severe dizziness 
  • Confusion
  • Changes in behavior 
  • Changes in consciousness

Diagnosis

Because some of the causes of a lopsided face are serious and require prompt treatment, the immediate medical evaluation is aimed at ruling out a stroke or an infection.

Often, the symptom history and physical examination will provide guidance regarding whether urgent testing or emergency treatments are needed. For example, a fever, pain, and swelling are signs of an infection. Confusion, vision changes, or trouble walking are signs of a stroke. 

Diagnostic testing is guided by your health history and physical examination and may include:

  • Blood tests to identify signs of infection or inflammation 
  • Brain imaging, such as brain magnetic resonance imaging (MRI) or brain computed tomography (CT) to identify a stroke 
  • Face or mouth X-ray to identify areas of trauma, cancer, or an abscess (a walled-off pocket of infection and pus)
  • Dental examination to identify teeth or mouth issues

Treatment

There are many different therapies for a lopsided face. The treatment depends on the cause. Treatments may alleviate the problem in some situations.

Treatment for Bell’s palsy, the most common cause of a lopsided face, is often a course of oral steroids. This can help improve the condition more quickly than it would improve on its own.

A stroke often requires emergency treatment with blood pressure control, fluid management, glucose (blood sugar) management, and sometimes blood thinners.

Other treatments for an uneven face may include Botox (botulinum toxin injection) to weaken certain muscles, which may even out the facial appearance. Surgical intervention is an option in some cases, and may include a nerve transfer.

After treatment of the medical issue causing the lopsidedness, rehabilitation is often necessary to help improve facial movements and improve the appearance of symmetry. This involves facial exercises, speech therapy, and swallow therapy.

Cosmetic Remedies

For a mild lopsided face, a different haircut or hairstyle can change the appearance of the face to make the sides look more even. Often, makeup can help if it's applied strategically. For some men, a beard can make the face look less lopsided.

Summary 

An uneven, asymmetrical face can be a normal variation from birth, and sometimes it can become more apparent with age. However, sometimes a lopsided face is a sign of a medical problem. There are so many different medical conditions that can cause it, including Bell’s palsy, stroke, and facial injury.

A diagnosis must be quick, so the treatment can be started immediately if needed. The treatment and prognosis depend on the cause. Treatment may include medication, surgery, rehabilitation, speech and swallow therapy, and cosmetic strategies. 

A Word From Verywell

Asymmetry of the face can be a health problem, and it can also make a person self conscious. You need to get urgent attention for any health problem that's causing your face to appear uneven. You also need to talk to your healthcare provider about concerns you have about your appearance.

There are many solutions for an uneven face, whether it's a congenital (from birth) issue or related to Bell's palsy or caused by a stroke or another condition. You can get complete or partial improvement with treatment.

Frequently Asked Questions

  • Does Bell's palsy only affect one side of the face?

    Yes, Bell’s palsy affects the facial nerve on one side, causing weakness on just that side of the face. There are reports of bilateral (both sides) Bell’s palsy, but this is not common.

  • What are the early signs of Bell’s palsy?

    Typically, Bell’s palsy causes rapid and severe weakness of the face, with an inability to raise the eyebrows, a droopy eyelid that won’t fully close, a droopy appearance of the face around the mouth and cheeks, and a lopsided smile.

    Sometimes people notice slight muscle tension in the face before the complete weakness of Bell’s palsy.

  • Is Bell’s palsy curable?

    Bell’s palsy generally improves on its own within weeks or months. Sometimes mild facial weakness can remain for a year or even longer. Treatment with oral steroids may speed up recovery.

4 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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