Facial asymmetry due to structural lesions will vary according to the location of the abnormality. A structural abnormality in the lower quadrant of the face will produce a persistent asymmetry that will not change with action. A structural abnormality in the upper quadrant of the face involving the eyelid will change, but not disappear, with action. An asymmetry due to an anomaly that prevents the affected eyelids from closing, such as a protruding eyeball, may decrease when the normal eye is wide open. An anomaly that keeps that affected eyelid closed may decrease when the normal eye is closed.

The most frequent structural anatomical lesions are molding, asymmetrical craniosynostosis, facial tumor, ocular pterygium, and eyelid swelling.