{
  "abstract": "Background/Objectives: Most healthy faces are mildly asymmetric, but how this asymmetry changes during growth and relates to facial size is unclear. We examined whether whole-face soft-tissue asymmetry increases as children grow and whether any increase simply reflects facial growth. Methods: We analysed 1014 three-dimensional facial scans of 377 children aged 6.0–18.8 years, followed for up to 3.2 years (median 2.0); the primary asymmetry analysis included 1003 scans of 376 children, after whole-face values with an isolated extreme point were set to missing. Asymmetry was the mean absolute perpendicular distance between the facial surface and its mirror image. Mixed-effects models separated within-child change from between-child differences. Repeat-capture reliability was not assessed. Results: Asymmetry increased by 3.2% per year within children entering at 11 years (95% confidence interval [CI], 2.2–4.1); older entrants were 2.7% more asymmetric per year of age (95% CI, 1.6–3.8). After adjustment for imaging session, the estimate was similar but imprecise (3.4%; 95% CI, −1.4 to 8.5). Facial size increased by 1.5% per year and asymmetry relative to size by 1.6%. Within children, asymmetry rose by about 1.7% for each 1% increase in facial size (exponent 1.73; 95% CI, 1.28–2.19); after adjustment for age this association was imprecise (0.89; 95% CI, −0.13 to 1.91), so the contributions of facial size and age could not be separated. Boys had 6.5% greater asymmetry; relative to facial size, 3.1% (95% CI, −2.0 to 8.6). Conclusions: On average, facial asymmetry increased modestly as children grew and increased relative to facial size over the observation period; whether this reflects facial enlargement itself or other age-related changes could not be determined. The estimated annual increase (about 0.013 mm) was below the residual variability between scans (about 0.04 mm); these population-level findings suggest that change cannot be detected in individual children, and individual monitoring and diagnostic thresholds require validated measurement.",
  "abstract_shown": true,
  "affiliations": [
    "Institute of Dentistry and Oral Sciences, Palacký University Olomouc, Palackého 12, 772 00 Olomouc, Czech Republic",
    "Department of Orthodontics, Jagiellonian University Medical College, Montelupich 4, 31-155 Kraków, Poland",
    "Radboudumc 3D Lab, Radboud University Medical Center, Philips van Leydenlaan 25, 6525 EX Nijmegen, The Netherlands",
    "Department of Dentistry, Section Orthodontics and Craniofacial Biology, Radboud University Medical Center, Philips van Leydenlaan 25, 6525 EX Nijmegen, The Netherlands",
    "Amalia Cleft and Craniofacial Centre, Radboud University Medical Center, Philips van Leydenlaan 25, 6525 EX Nijmegen, The Netherlands"
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 7,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Peter Direr"
    },
    {
      "affs": [
        1
      ],
      "name": "Marta Gibas-Stanek",
      "orcid": "0000-0002-9837-0223"
    },
    {
      "affs": [
        2,
        3
      ],
      "name": "Robin Bruggink",
      "orcid": "0000-0003-0316-648X"
    },
    {
      "affs": [
        0
      ],
      "name": "Petra Kaminkova",
      "orcid": "0000-0001-6633-0297"
    },
    {
      "affs": [
        3,
        4
      ],
      "name": "Mette Kuijpers",
      "orcid": "0000-0001-6462-9789"
    },
    {
      "affs": [
        2
      ],
      "name": "Thomas Maal"
    },
    {
      "affs": [
        1
      ],
      "name": "Piotr S. Fudalej",
      "orcid": "0000-0001-8777-7434"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/2h8f7xswq05gm.bib",
  "cited_by": 0,
  "doi": "10.3390/jcm15218583",
  "fulltext_url": null,
  "id": "2h8f7xswq05gm",
  "issns": [
    "2077-0383"
  ],
  "landing_url": "https://www.mdpi.com/2077-0383/15/21/8583",
  "language": null,
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [],
  "openalex": null,
  "pdf_url": null,
  "pmcid": null,
  "pmid": null,
  "published": "2026-11-04",
  "publisher": "MDPI AG",
  "ris": "https://research.draconitic.com/paper/2h8f7xswq05gm.ris",
  "sources": [
    {
      "first_seen": "2026-11-05T00:21:10Z",
      "native_id": "10.3390/jcm15218583",
      "source": "crossref",
      "url": "https://www.mdpi.com/2077-0383/15/21/8583"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "journal-openalex:F27",
      "subfield": "general"
    }
  ],
  "title": "Development of Facial Soft-Tissue Asymmetry During Growth: A Mixed-Longitudinal Three-Dimensional Study",
  "title_text": "Development of Facial Soft-Tissue Asymmetry During Growth: A Mixed-Longitudinal Three-Dimensional Study",
  "type": "peer-reviewed",
  "updated_at": "2026-11-06T00:21:25Z",
  "url": "https://research.draconitic.com/paper/2h8f7xswq05gm",
  "venue": "Journal of Clinical Medicine",
  "versions": []
}