Why Does One Side of Your Face Age Faster Than the Other? The Surprising Science of Facial Asymmetry

Last updated: 2 November 2026

Have you ever looked in the mirror and noticed that one side of your face seems to be ageing faster than the other? One cheek looks a little flatter. One nasolabial fold runs deeper. One eyebrow sits lower, or the skin at the corner of one eye is more creased than its partner. Most of us have a favourite side for photographs, and most of us have a theory about why: the pillow, the car window, the side we chew on.

As an NHS GP and aesthetic doctor in Hale, I hear this in consultations every week, and the science behind it is more interesting than the social media explanations. Our faces are not symmetrical to begin with, and research shows asymmetry increases with age. Some of the popular causes hold up surprisingly well, one of them is a case study that went round the world, and one, the one everyone repeats, is barely supported at all. This article goes through the evidence, what can and cannot be done about it, and the one situation where a change in facial symmetry needs urgent medical attention rather than a consultation with me.

In this article:

• Is it normal for one side of your face to look older?
• Does facial asymmetry really increase with age? The 3D scanning study
• Why do the two sides of the face age differently?
• Does sleeping on one side age that side faster?
• Could driving be ageing one side of your face?
• What about chewing or smiling more on one side?
• Can aesthetic treatments correct facial asymmetry?
• When a change in symmetry is not about ageing
• What can you actually do to prevent uneven ageing?
• Frequently asked questions

Is it normal for one side of your face to look older?

Yes, and it is one of the first things I explain in an aesthetic consultation. Almost nobody has a symmetrical face. One cheekbone sits more forward. One eyebrow rides higher. One side of the jaw has a different contour, and one eye is marginally larger. These differences come from how the skull develops, how fat and soft tissue are distributed, how the teeth meet and how each person habitually uses their muscles.

Symmetry is also not the same thing as beauty. Faces that have been digitally mirrored to be perfectly symmetrical look oddly artificial, and the small differences between your two sides are part of what makes you recognisably you. The job of good aesthetic medicine is not to erase every difference between the two sides of a face. It is to work out which differences are simply yours, which have developed with time, and whether anything would improve balance without stealing character.

Does facial asymmetry really increase with age? The 3D scanning study

The best evidence comes from a 2018 study in Plastic and Reconstructive Surgery that measured faces rather than asking people how they felt about them.

The 2018 study	Detail
Who	191 volunteers aged from four months to 88 years
How	Three dimensional surface scans of each face, mirrored and compared, detecting differences of a fraction of a millimetre
What they found	A highly significant correlation between age and asymmetry: about 0.06 mm more difference between the two sides for every decade of life, with the biggest changes in the lower two thirds of the face, from the eyebrows down
What did not matter	Sex and ethnicity made no significant difference
Limits	It compared people of different ages at one moment rather than following the same faces for decades, so it shows a pattern, not a guarantee for any individual

"We found a highly significant positive correlation between increasing age and facial asymmetry." Linden OE, Taylor HOB et al., Plastic and Reconstructive Surgery, 2018.

A few hundredths of a millimetre per decade sounds trivial, but it accumulates, it concentrates in the cheeks, folds and jawline where we notice it most, and it sits on top of whatever asymmetry you started with. The two sides of the face do not change in precisely the same way or at precisely the same rate, and that matches what I see in clinic every day.

Why do the two sides of the face age differently?

Facial ageing is not a skin problem with a bit of sagging attached. It happens in four layers, and each can age at a slightly different pace on each side.

Layer	What changes with age	Why one side can differ
Bone	CT studies show the eye sockets widen, the cheekbone and the bone beside the nose recede, and the jaw loses height and projection	The skull was never symmetrical; as the foundation shrinks, a small original difference becomes more visible in the tissue it supports
Fat compartments	Facial fat sits in separate pockets, not one sheet; the deep pockets shrink and the superficial ones slide down	Pockets are not identical in size or position on each side, so similar shrinkage produces an unequal result
Muscle	Expression muscles keep creasing the skin above them for a lifetime	Most people smile, frown and raise an eyebrow more strongly on one side
Skin	Collagen and elastin decline; UV fragments what is left and adds pigmentation	Sun exposure is the one factor that can be strongly one sided, as the driving evidence below shows

This is why a deeper fold on one side does not necessarily mean that side has lost more collagen or is "ageing faster" in any meaningful sense. It usually reflects pre existing asymmetry in bone and fat, made more visible by ageing that is happening fairly evenly. It is also why adding filler to the flatter cheek is not automatically the answer; the difference may live in bone, in muscle use or in skin quality, and sometimes in all four layers at once.

Does sleeping on one side age that side faster?

This is the explanation patients arrive with most often, and it is the one with the weakest evidence.

Claim	What the evidence says	Verdict
"Sleep wrinkles are real"	A 2016 review in Aesthetic Surgery Journal describes how compression and shear against the pillow create creases that run in a different direction from expression lines, typically on the forehead, cheek and around the mouth	True; the pillow crease you see at 7am is a sleep wrinkle, and in thinner older skin it takes longer to fade
"It gets worse as you age"	The same review notes we change position about 27 times a night when young and about 16 when older, so each position is held for longer	Plausible; more time in one position on less elastic skin
"Your sleeping side is your older side"	A 2013 study in Dermatologic Surgery compared women's preferred sleeping side with the side showing more wrinkles and descent, and found no statistically significant relationship	Not supported; the only study that tested the claim directly could not confirm it
"So I should train myself to sleep on my back"	The 2016 authors do recommend back sleeping and pillows that reduce facial distortion, as the only way to avoid the mechanism entirely	Only if it costs you nothing; poor sleep ages skin far more reliably than a pillow does

"The consequence of repetitive stretching of facial tissue over time is intriguing and warrants further study." Anson G, Kane MAC, Lambros V, Aesthetic Surgery Journal, 2016.

So there is a real mechanism, a plausible reason it matters more as skin thins, and no good evidence that it decides which side of your face looks older. If you sleep well on your side, keep doing it. A silk pillowcase is a pleasant thing to own and will not do any harm, but I would not sacrifice an hour of sleep for a symmetry theory that the one direct study could not confirm.

Takeaway: asymmetry is normal, it increases measurably with age, and it comes mostly from bone and fat that were never identical on both sides. The pillow is a minor character in this story.

Could driving be ageing one side of your face?

Here the evidence is much stronger, because the culprit is ultraviolet light, the single biggest external cause of skin ageing, and because exposure in a car is reliably one sided.

Evidence	What was found	What it means in the UK
The delivery driver, New England Journal of Medicine 2012	A 69 year old man who had driven a delivery truck for most of his working life, with more than 25 years of UVA through the driver's window on his left. That side showed deep thickening, furrows and sun damage; the right looked years younger. Diagnosed as unilateral dermatoheliosis	He was in the United States, where the driver sits on the left. In the UK the driver's window is on the right, so it is the right side of the face that takes the extra exposure
Car windows, JAMA Ophthalmology 2016	29 cars from 15 manufacturers: windscreens blocked an average of 96% of UVA, side windows only 71%, and only four of the 29 blocked more than 90% through the side glass	Your windscreen is laminated and protects you; your side window usually is not. Protection varies a lot between models, so do not assume
UVA and ageing	UVA penetrates to the dermis, fragments collagen, drives pigmentation and passes through cloud and ordinary glass year round	A Cheshire commute in February still counts; it is the cumulative dose over years that shows

"We were quickly amazed at the stark one-sidedness of his condition." Dr Jennifer Gordon, Northwestern University, one of the authors of the 2012 case report.

One dramatic case does not mean every driver ends up lopsided, and the degree of exposure depends on the car, the route, the time of day and how long you spend behind the wheel. But of all the theories patients bring me, this is the one with a measurable mechanism and real world proof. If you drive a lot, broad spectrum SPF on the right side of your face and neck is not vanity, it is sense, and it applies to pigmentation and skin cancer risk as much as to wrinkles. If you have noticed sun damage that is markedly worse on one side, that is worth showing your GP.

What about chewing or smiling more on one side?

Habit	Is it plausible?	What I would actually do
Chewing on one side	Yes, up to a point. The masseter responds to load like any muscle, and a bulkier masseter visibly widens that side of the jaw. But chewing side is usually dictated by teeth, bite and jaw joint, not choice	If one side of your jaw is noticeably wider, or you clench or grind, see your dentist first. Where one masseter is clearly overactive, anti wrinkle injections can rebalance it following consultation
Smiling, frowning or raising one eyebrow more	Yes. Expression lines follow muscle use, and almost everyone uses their face asymmetrically. Direct long term evidence is limited, but the mechanism is the same one that makes expression lines in the first place	This is where anti wrinkle injections are at their most useful for asymmetry: different doses on each side can level a brow or soften one deeper crow's foot, following consultation
Being right or left handed	No good evidence that your dominant hand predicts your older side	Nothing
Resting your chin on one hand, phone on one shoulder	Possible for sustained daily pressure, in the same way sleep creases are, but unstudied	Worth noticing; not worth worrying about

Can aesthetic treatments correct facial asymmetry?

Sometimes, and the first question is always whether correction is needed at all. When it is, the right tool depends on which layer the difference lives in, which is why I assess the whole face rather than the single fold a patient points to.

Type of asymmetry	What may help	The limits
Volume: one flatter cheek, one deeper fold	Precisely placed dermal filler, usually more on one side than the other, or Sculptra to rebuild support gradually	Filling the flatter side to match can overfill if the real difference is bone; the aim is balance, not a mirror image
Muscle: one higher brow, one deeper crow's foot, a lopsided smile line	Anti wrinkle injections dosed differently on each side, reviewed at two to four weeks, following consultation	Results are temporary and need maintaining; over correcting can create a new asymmetry
Skin: more sun damage, pigmentation or texture change on one side	Medical grade skincare with a retinoid and daily SPF, chemical peels, microneedling or polynucleotides	Skin quality improves over months, not days, and the SPF has to continue or the difference returns
Structure: a clearly different jaw or cheekbone on each side	Non surgical treatments can soften the appearance; significant skeletal asymmetry is a surgical or orthodontic question	I will tell you if what you are asking for is not something injectables can deliver

No injectable can guarantee symmetry, and chasing every small difference leads to over treatment. My preference is to preserve the natural character of a face rather than create a mathematically even one. Very often the most useful outcome of an asymmetry consultation is reassurance.

When a change in symmetry is not about ageing

Everything above concerns gradual change over years. A sudden change is different. New drooping on one side of the face, a mouth that will not lift evenly, an eye that will not close, slurred speech or weakness in an arm can be signs of a stroke, and the right response is to call 999 immediately, not to book a consultation. Other causes of new one sided facial weakness, such as Bell's palsy, also need prompt assessment by your GP or an urgent care service rather than an aesthetic clinic. I am a GP as well as an aesthetic doctor, and if someone describes a recent change in how their face moves, that is the conversation we have first.

What can you actually do to prevent uneven ageing?

Measure	Strength of evidence	What to do
Daily broad spectrum SPF, including in the car	Strong; the only measure with a case report of what happens without it	SPF 30 or higher with UVA protection, every morning, and reapplied before a long drive; do not forget the right side of the neck and the right hand
A retinoid and a consistent routine	Strong for skin quality generally	Treat both sides the same; the skin layer is the one you have most control over
Sleeping on your back	Weak for asymmetry; mechanism real, outcome unproven	Only if it does not cost you sleep; a smoother pillowcase is a harmless middle ground
Chewing evenly	Not an established anti ageing measure	See a dentist if you favour one side because the other hurts or is missing teeth
Accepting that asymmetry is normal	Strong, and under rated	Nobody else is measuring your two sides; front camera selfies and overhead lighting exaggerate every difference

When somebody tells me one side of their face is ageing faster, I do not reach for the pillow explanation. I look at the bone, the fat, the muscle pattern and the skin, I ask about driving and sun, and I ask whether the difference is new. At my clinic in Hale the answer is sometimes a carefully asymmetric treatment plan and sometimes a reassurance that what they are seeing is simply their face, doing what every face does. Those small differences are part of what makes a face look real, expressive and individual.

Takeaway: protect the sun facing side, treat both sides with the same good skincare, sleep however you sleep best, and let a whole face assessment decide whether the difference needs anything more than acceptance.

Frequently asked questions about uneven facial ageing

Why is one side of my face more wrinkled than the other?

Usually a combination of asymmetry you were born with in bone and fat, stronger muscle use on one side, and unequal sun exposure. Sleep position can add temporary creases, but the one study that tested whether your sleeping side becomes your more wrinkled side found no significant link.

Does sleeping on your left side cause more wrinkles on the left?

Not according to the available evidence. Sleep creases are real and fade more slowly in older skin, but a 2013 study found no significant relationship between women's preferred sleeping side and the side showing more wrinkles or sagging.

Why is one cheek saggier or flatter than the other?

Facial fat sits in separate compartments that are rarely identical on both sides, over bone that is rarely symmetrical either. As fat shrinks and descends with age, the original difference becomes more visible. It does not usually mean that cheek is ageing faster.

Can driving cause one side of your face to age faster?

Yes, with long cumulative exposure. Side windows block far less UVA than windscreens, an average of 71% against 96% in one study, and a well known case report shows severe one sided sun damage in a lifelong delivery driver. In the UK it is the right side of the face at risk.

Which side of the face ages faster in the UK?

If driving is a factor, the right, because that is the side nearest the driver's window. For everyone else there is no universal "faster" side; it depends on your own anatomy and habits.

Does facial asymmetry get worse with age?

Yes. A 2018 study using 3D scans of 191 people aged four months to 88 years found asymmetry increased steadily with age, by around 0.06 mm per decade, mostly in the cheeks, mouth and jaw.

Does your dominant hand decide which side ages faster?

There is no good evidence that being right or left handed determines which side of your face ages faster.

Can anti wrinkle injections correct an asymmetrical face?

Where the asymmetry comes from muscle, such as one brow sitting higher or one crow's foot being deeper, dosing differently on each side can improve balance, following consultation. They cannot correct asymmetry that comes from bone or fat.

Can dermal filler make your face more symmetrical?

Carefully placed filler can soften differences in volume and contour, often with more product on one side. Complete symmetry is neither always achievable nor desirable, and filling to match can overfill if the underlying difference is skeletal.

When should I worry about one side of my face changing?

Gradual change over years is normal. A sudden droop, a mouth that will not lift evenly, an eye that will not close, slurred speech or arm weakness can be signs of a stroke: call 999. Any new one sided facial weakness should be assessed urgently by a doctor, not an aesthetic clinic.

Is it normal for one side of my face to look older?

Yes. Mild asymmetry is universal and becomes a little more noticeable with age. Most people are far more aware of their own than anyone else is.

Next steps

If you would like a proper whole face assessment of why one side looks different, which layer the difference lives in and whether anything is worth doing about it, I would be glad to see you for a consultation at the clinic in Hale. Sometimes the answer is a plan; often it is a relieved conversation.

Learn more about Dr Caroline Warden Clinic

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Learn more about other treatments offered

Further reading

• The Best Aesthetic Treatments for Your 30s, 40s and 50s
• Why Your Face Changes in Your 40s and What Actually Helps
• Why Skin Tightening Is One of the Biggest Myths in Aesthetics
• Beauty Sleep: Is It Really a Thing?
• Which Treatment Do I Need? Matching Concerns to Treatments
• Dermal Fillers in Hale and Altrincham (for differences in volume)
• Anti Wrinkle Injections in Hale and Altrincham (for differences in muscle)
• Medical Grade Skincare in Hale (for differences in sun damage)

Dr Caroline Warden (GMC 6157708) is an NHS GP with over 19 years of clinical experience, an independent prescriber, and holds a Level 7 postgraduate diploma in cosmetic injectables. She has practised aesthetic medicine since 2017 and runs Dr Caroline Warden Skin & Aesthetic Clinic with her sister Louise at 2 Crown Passages, Hale, Cheshire, WA15 9GN, serving patients from Hale, Altrincham, Bowdon, Hale Barns, Timperley, Sale, Alderley Edge, Wilmslow, Knutsford, Didsbury and across Cheshire and South Manchester. You will only ever be seen and treated by Dr Warden. Prescription only medicines are prescribed following a face to face consultation and are not promoted in this article. This article provides general educational information and does not replace an individual assessment. Information correct as of November 2026.

References

1. Linden OE, He JK, Morrison CS, Sullivan SR, Taylor HOB. The relationship between age and facial asymmetry. Plastic and Reconstructive Surgery 2018;142(5): pages 1145 to 1152. Read the study
2. American Society of Plastic Surgeons. Facial asymmetry increases with age, press release, October 2018 (author quote). Read the release
3. Anson G, Kane MAC, Lambros V. Sleep wrinkles: facial aging and facial distortion during sleep. Aesthetic Surgery Journal 2016;36(8): pages 931 to 940. Read the review
4. Kotlus BS. Effect of sleep position on perceived facial aging. Dermatologic Surgery 2013;39(9): pages 1360 to 1362. Read the abstract
5. Gordon JRS, Brieva JC. Unilateral dermatoheliosis. New England Journal of Medicine 2012;366:e25. Read the case report
6. Northwestern University Feinberg School of Medicine. Viral photo offers evidence of sun's aging effect on skin, 2012 (Dr Gordon quote). Read the article
7. Boxer Wachler BS. Assessment of levels of ultraviolet A light protection in automobile windshields and side windows. JAMA Ophthalmology 2016;134(7): pages 772 to 775. Read the study
8. Mendelson B, Wong CH. Changes in the facial skeleton with aging: implications and clinical applications in facial rejuvenation. Aesthetic Plastic Surgery 2012;36(4): pages 753 to 760. Read the abstract