There are a couple of issues here to think about. Â If you have a significant drop on one side, this affects the coat in two chief ways: it makes the shoulders look asymmetrical, as has been discussed. Â It also throws off the button point: one side (the dropped side) of the coat will hang down longer than the other side. Â So, when unbuttoned, the coat looks uneven; and when buttoned, the lapel on the dropped side will "bow" or "bulge" out in an unsightly way while the other side looks clean. The latter problem can be corrected by taking up the dropped side of the coat at the shoulder seam, adjusting the collar, etc. Â But your shoulders will still look uneven. Â The "symmetricality" issue requires padding to correct, so far as I know. Â There is simply no other way to raise the shoulder line. Â Tailors can give the shoulder some pitch and have it rise at the sleevehead through cutting and sewing alone, but this does not raise the overall line. Â So if you have shoulders that are significantly different, and you want the angle, line, and level of each shoudler from collar to sleevehead to be absolutely identical, then, yes, at least the dropped side will need a little padding.