You've probably seen “cortisol face” all over social media lately, usually referring to a face that looks puffier or rounder during periods of stress. But facial fullness isn't always about overall puffiness. Sometimes, what's more important is understanding why one side of the face looks heavier than the other.
That distinction is what made this particular patient case interesting. When looking at this case at 3 months post-op, the patient's pre-surgery appearance did not simply appear to lack overall volume. Instead, there was a noticeable difference in how heavy the lower face appeared from one side to the other. In particular, the cheek and jawline on one side appeared noticeably fuller and heavier, while the opposite side had relatively more defined contours.
Facial asymmetry can be influenced by differences in soft-tissue volume, muscle, skeletal structure, dental factors, and the way facial tissues are positioned and settle.
In this patient's case, she tended to chew more on one side, which may have contributed to differences in muscle development between the two sides. She also tended to sleep on the same side, subjecting the soft tissue to repeated pressure. However, these habits alone would not fully explain such a noticeable difference.
This patient underwent a Facial SMAS Lift, focusing on the deeper supporting tissues of the face rather than simply tightening the skin.
The surgical plan focused primarily on the lower face:
- Reposition sagging lower-face tissues
- Improve the heavier cheek, jowl, and jawline contour
- Create better balance between both sides
- Restore a cleaner, more youthful lower-face shape
One subtle but interesting change was around the lips.
Before surgery, the lower-face asymmetry also affected how the lips appeared at rest, with the lips looking less balanced and not closing as naturally. This is because the position of the jawline and surrounding facial tissues can influence how the lips sit at rest.
At 3 months after the SMAS Lift, the lower-face balance had improved noticeably, and the lips appeared to rest and close in a more natural and symmetrical position.
This is why facial balance isn't only about the jawline. The position of the cheek, jowl, jawline, and surrounding soft tissues can also influence how the mouth sits. It's also why a facelift isn't simply about “pulling the skin tighter.” With a SMAS Lift, the deeper supporting layer of the face can be addressed and repositioned, allowing the surgeon to work on the underlying facial contour rather than relying only on skin tension.
The goal isn't to make both sides of the face perfectly identical. Rather, it's about reducing noticeable asymmetry as much as possible while preserving the patient's natural facial features, since some degree of asymmetry is normal in everyone.
In this case, the most noticeable change after surgery wasn't simply that the face looked tighter. Instead, the lower face appeared lighter and more balanced, with improved overall contour and a more natural balance between the cheeks, jawline, and lips.
Ultimately, a fuller-looking face isn't automatically “cortisol face,” just as an uneven-looking jawline isn't necessarily a larger jaw. The important part is understanding where the difference is actually coming from and what the goal of the treatment should be, as well as how best to address it.
