A flat-looking side profile usually comes down to how far your midface projects forward relative to your forehead and chin. The middle third of your face, from just below your eyes to just above your upper lip, is built on a bone called the maxilla. When this bone is naturally less prominent, or when the soft tissue over it loses volume, your profile can look concave or “scooped in” rather than gently curved. Several factors determine how much projection you have, and most of them are either inherited or age-related.
How Bone Structure Creates a Flat Profile
Your facial profile is shaped primarily by three landmarks: the forehead, the midface (maxilla and cheekbones), and the chin. In a balanced profile, the midface sits slightly forward, creating a gentle convex curve from forehead to chin. Orthodontists measure this using a “facial convexity angle.” Profiles with an angle below about 6 degrees are classified as concave, meaning the midface is set back relative to the forehead and chin. That’s what reads as “flat” from the side.
The most common skeletal reason is a smaller or more recessed upper jaw. This is sometimes called midface retrusion. In some people, the lower jaw also sits further forward than average, which exaggerates the contrast and makes the middle of the face look even flatter. This combination produces what dentists call a Class III relationship: the lower teeth and jaw lead while the upper jaw trails behind, creating a concave, dish-shaped profile.
Genetics play a large role. The size and position of your maxilla and cheekbones are largely inherited traits. Certain populations naturally have flatter midface structures, and research confirms that skeletal patterns like bite depth and jaw proportion vary significantly across ethnic groups, reflecting inherited facial architecture rather than environmental influences. If your parents or siblings share a similar profile, bone structure is the most likely explanation.
Why Your Profile Can Flatten With Age
Even people who had good midface projection in their twenties can notice their profile flattening over time. This happens because of two simultaneous processes: bone resorption and fat loss.
Your upper jaw slowly shrinks throughout adulthood. Recent research tracking patients over eight years found that maxillary height decreases by about 0.3 millimeters per year in people who still have their teeth, and as much as 0.8 millimeters per year in those who’ve lost teeth. By the seventh decade of life, maxillary height typically decreases by 8 to 15 percent overall. Postmenopausal women experience roughly 35 percent more bone loss in this area than other adults. As the bone recedes, the base of the nose and upper lip lose their underlying support, and the entire midface settles backward and downward.
Fat loss compounds the problem. Your cheeks contain two distinct layers of fat, a deep layer attached directly to the bone and a superficial layer closer to the skin. The deep layer acts like scaffolding, propping up everything above it. Starting around age 40, these fat compartments begin to shrink in a predictable sequence. The area just below the eye socket (the malar region) is one of the first to deflate. As deep cheek fat shrinks and the ligaments holding everything in place weaken, the superficial fat slides downward. The result is a flattened cheek, a more prominent tear trough, and a deepening fold between the nose and mouth. Buccal fat loss in the lower cheek can also create a hollow, concave look from the side.
How Your Nose and Chin Affect Perception
Sometimes the midface itself isn’t the issue. Your profile is a relationship between parts, and the nose and chin can make the midface look flatter than it actually is. A useful reference is the “E-line,” a concept developed by orthodontist Robert Ricketts: an imaginary line drawn from the tip of the nose to the tip of the chin. In a balanced Caucasian profile, the upper lip sits about 4 millimeters behind this line and the lower lip about 2 millimeters behind it.
If your nose is especially prominent or your chin projects strongly forward, the midface will appear recessed by comparison, even if the maxilla is a normal size. Conversely, a small chin can make the entire lower face look pushed back. Profile balance is about proportion. A face where one feature is significantly larger or smaller than the others will read as “flat” in the areas that don’t match.
Mouth Breathing and Developmental Habits
How you breathed and held your mouth during childhood can permanently affect your bone structure. Chronic mouth breathing during the growth years encourages a longer, narrower face with less forward development of the upper jaw. When the tongue rests low in the mouth instead of pressing against the roof (the palate), the maxilla doesn’t receive the gentle outward pressure that helps it grow forward. The result is a narrower palate, a more recessed midface, and a flatter profile. These changes are largely set by the time skeletal growth is complete in the late teens or early twenties.
Surgical Options for Structural Flatness
When a flat profile is caused by a genuinely recessed upper jaw, the most definitive correction is a surgical procedure called a LeFort I osteotomy. This involves carefully separating the upper jaw from the rest of the skull, repositioning it forward (and sometimes downward or upward), and securing it with small plates and screws. It’s one of the most common reasons this surgery is performed, particularly for people with a Class III bite where the lower jaw sits ahead of the upper.
The process requires months of orthodontic preparation beforehand to align the teeth so they’ll fit together properly once the jaw is moved. Recovery typically involves several weeks of swelling, a modified diet, and follow-up orthodontics. The results are permanent because the bone heals in its new position. For people whose flatness is primarily skeletal, this is the only approach that changes the underlying architecture.
Cheekbone implants or custom facial implants placed over the maxilla are another surgical route, particularly when the jaw alignment is fine but the cheekbones or midface simply lack projection.
Non-Surgical Ways to Add Projection
For milder cases, or for age-related flattening, injectable fillers can restore midface projection without surgery. The most effective technique targets the deep fat compartments directly on the bone surface. Practitioners typically place small deposits of hyaluronic acid filler in three key deep compartments beneath the cheekbone and along the upper jaw. Because these deep compartments don’t slide downward the way superficial fat does, filler placed at this level provides structural support and increases forward projection of the entire cheek.
Filler can also be placed along the base of the nose where the maxilla has receded, restoring support to the upper lip and the crease between nose and cheek. Results are immediate and typically last 12 to 18 months before the filler gradually dissolves. This approach works best for people whose bone structure is reasonably balanced but who’ve lost the soft tissue volume that once gave their profile dimension.
For younger people with mild flatness, orthodontic treatment can sometimes improve the profile by moving the upper teeth and their supporting bone slightly forward, though this is limited in how much skeletal change it can achieve in adults. In growing children and teenagers, palate expanders and functional appliances have a larger window to influence how the upper jaw develops.