Survivals and local control are comparable among the four different local therapy strategies used for pediatric head and neck rhabdomyosarcoma (HNRMS) include proton therapy (PT), photon therapy (RT), surgery with radiotherapy (Paris-method), and surgery with brachytherapy (AMORE). With data of 173 HNRMS survivors treated at four institutions in Europe and North America, this study investigated facial deformation caused by these four treatment modalities. All survivors showed significantly reduced facial growth (p < .001) and significantly more asymmetric compared to healthy controls, independent of treatment modality (p ≤ .001). In survivors with a parameningeal tumor, there was significantly less facial deformation in PT when compared to RT (p = .009) and Paris-method (p = .007).