Anthropometric Analysis of the Human Skull for Developmental Left-Sided Asymmetry, New Finding

  • Abbas Kazemi Ashtiani
  • Mahdokht Azarbakhsh
  • Farhad HafeziEmail author
  • Bijan Naghibzadeh
Original Article Basic Science/Experimental



Facial and cranial asymmetry is common in bilateral vertebrates, particularly human beings. Through years of injecting fillers and performing face-lift operation on patients, we began to observe that more fillers were required on the right side to reach symmetry and also more loose skin and soft tissue was observed on the right side in the majority of patients (Fig. 5). Here, we conducted an analytical study to comprehensively measure human skulls in order to observe and quantify this difference.


We collected forty-one natural skulls available from five medical schools of Tehran province in Iran. Standard photography was conducted from the front, lateral, and superior views. Measurements and statistics were completed using Image J software (National Institutes of Health) for exact comparison of fixed-point distances on the samples.


Comparison of right and left dimensions on the skulls revealed several fixed asymmetries. The most significant differences were measurements around the orbit. The distance between the upper orbit point and zygion (zy), zygion to sub-nasal, and orbital areas were significantly larger on the left side. Measuring the anterior gonion–pogonion distance showed a wider mandibular body on the left side. We did not find any considerable differences between any other left-sided and right-sided skull dimensions.


Asymmetry of the face and body is a general rule in human anatomy, but correlation and consistency of this asymmetry between the left and right sides is a novel finding based on our measurements. Our findings showed that the orbit was significantly bigger in width, height, and surface area on the left side. We also quantified a narrower mandible on the right side. We hope these findings can be translated to aesthetic surgery practice to make the plastic surgeon and patient more familiar with the patient’s specific anatomy in order to better predict, plan, and successfully implement aesthetic procedures such as injecting fillers or doing peri-orbital procedures.

No Level Assigned

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors


Facial asymmetry Left sidedness Skull 


Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflicts of interest to disclose.

Human and Animal Rights

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed Consent

For this type of study, informed consent is not required.


  1. 1.
    Hafezi F, Javdani A, Naghibzadeh B, Ashtiani AK (2017) Laterality and left-sidedness in the nose, face, and body: a new finding. Plast Reconstr Surg Glob Open 5(12):e1590CrossRefGoogle Scholar
  2. 2.
    Hafezi F, Naghibzadeh B, Nouhi A, Yavari P (2010) Asymmetric facial growth and deviated nose: a new concept. Ann Plast Surg 64(1):47–51CrossRefGoogle Scholar
  3. 3.
    Hafezi F, Naghibzadeh B, Ashtiani AK, Guyuron B, Nouhi AH, Naghibzadeh G (2014) Straight septum, crooked nose: an overlooked concept. Aesthet Plast Surg 38(1):32–40CrossRefGoogle Scholar
  4. 4.
    Blum M, Feistel K, Thumberger T, Schweickert A (2014) The evolution and conservation of left-right patterning mechanisms. Development 141(8):1603–1613CrossRefGoogle Scholar
  5. 5.
    Levin M (2004) The embryonic origins of left-right asymmetry. Crit Rev Oral Biol Med 15(4):197–206CrossRefGoogle Scholar
  6. 6.
    Rohrich RJ, Villanueva NL, Small KH, Pezeshk RA (2017) Implications of facial asymmetry in rhinoplasty. Plast Reconstr Surg 140(3):510–516CrossRefGoogle Scholar
  7. 7.
    Gawlikowska-Sroka A (2013) Analysis of variation of orbital openings in contemporary skulls. Ann Acad Med Stetin 59(1):76–80PubMedGoogle Scholar
  8. 8.
    Ercan I, Ozdemir ST, Etoz A, Sigirli D, Tubbs RS, Loukas M, Guney I (2008) Facial asymmetry in young healthy subjects evaluated by statistical shape analysis. J Anat 213(6):663–669CrossRefGoogle Scholar
  9. 9.
    Kim EJ, Palomo JM, Kim SS, Lim HJ, Lee KM, Hwang HS (2011) Maxillofacial characteristics affecting chin deviation between mandibular retrusion and prognathism patients. Angle Orthod 81(6):988–993CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2019

Authors and Affiliations

  1. 1.Burn Research Center, Fatima HospitalIran University of Medical SciencesTehranIran
  2. 2.Ilam Health SuthrityTehranIran
  3. 3.Loghman Hakim HospitalShahid Beheshty University of Medical SciencesTehranIran

Personalised recommendations