In our weekly Post Your Face column, Dr. Robert Freund answers readers' cosmetic surgery questions, and shows them how they'd look if they underwent the enhancement. To post your own face, visit

The Patient's Question:
Over the years, my face has grown very lopsided. It's even more so when I smile. My skin tone has also worsened with each of my 4 children. I have tried several creams and even had a facial mask applied by my dermatologist, but I keep breaking out. I'm 38 years old! What can I do?

Before (left) and after (right) hypothetical treatment. Courtesy Photo

Dr. Freund's Answer: You have two distinct issues that I will address individually. Your concerns about your complexion are similar to those of many men and women. Chronic acne and blemishes improve with dermatologic treatments, only to recur in spite of treatment. Over-the-counter treatments like Benzoyl Peroxide, Salicylic Acid wipes or lotions, and acne facial scrubs will resolve blemishes for a while but they will often occur again. These medications can also make your skin extremely dry. The other approach is to see your dermatologist – he or she can prescribe topical or oral antibiotics, Retin-A or Accutane. Both are more effective than the over-the-counter solutions, but should only be used if you are not planning to have any more children.

As for your worsening facial asymmetry, I suspect that this may be the result of a process called Hemifacial Atrophy (Romberg's Syndrome). This process can be slow in development and require steroids to stop its progression. For a cosmetic fix to the asymmetry, the best and quickest method is autologous Fat Transfer. This is a technique in which fat is taken from one part of your body, processed, and injected into the face to replace the soft tissue that has been lost. The newest technique, Viafill (note: I am the inventor of Viafill; you can read more about it at would address your problem very effectively. Just a warning: because of the large amount of fat required to return symmetry to your face, you would probably need 2-3 treatments. The cost for this procedure would be $5,000-$7,000 for the entire process.

Respectfully submitted,

Robert Freund, MD, FACS

The health or medical information in this article is for informational purposes only and is not intended to be used as a substitute for professional medical advice, diagnosis or treatment. Please consult your doctor or a qualified healthcare provider with any questions.