Facial Asymmetry as a Universal Signature: A Morphometric, Perceptual, and Artistic Approach.

Background: Facial asymmetry is universal, yet its directionality and its relationship with patients' self-perception remain underexplored. This study evaluates the association between 3-dimensional-measured malar asymmetry and the patient's declared "better side" in an aesthetic population. Methods: One hundred twenty consecutive patients were photographed in standardized frontal view using the Vectra H2 system. Malar width was assessed by measuring the zygion-midline distance on each side, recorded twice and averaged. Patients completed a 10-item ad hoc questionnaire addressing their preferred side, perceived asymmetries, photographic habits, and mirror-photograph differences. Observed frequencies were compared to a theoretical 50/50 distribution using chi-square testing. Results: Objective asymmetry was present in 98.3% of subjects, with a wider left side in 118 cases ( Conclusions: Although a left-sided directional asymmetry predominates, it does not align with patients' stated preferences or their subjective self-image. Recognizing this dissociation between structure and perception during consultation improves expectation management and reduces postoperative misunderstandings in facial aesthetic procedures.