The authors present a series of seven patients who have a diagnosis fitting that of combined ipsilateral facial and somatic hemiatrophy. Diagnostic features include facial, tongue, and ear asymmetry and associated decreases in length and size of the ipsilateral limbs. The symptomatic problems related to leg length discrepancy can be addressed in the usual fashion, and this condition does not appear to progress to large leg length discrepancies. The cosmetic side of this disorder is often concerning: it is the most reliable identification of the existence of this condition and is present from birth. Facial hemiatrophy is mild and does not appear to be progressive. The hemiatrophies probably have a multifactorial pathogenesis that most likely has at its basis a genetic cause.