American Association of Plastic Surgeons

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The Frequency of Periorbital Asymmetry
Ji H. Son, MD, John Chao, BS, Bahman Guyuron, MD.
University Hospitals Case Medical Center, Cleveland, OH, USA.

PURPOSE: Facial asymmetry is ubiquitous. Patients are likely to discern asymmetry especially after cosmetic procedures. The purpose of the study was to assess asymmetries in eyebrows and eyelids in patients considering cosmetic surgery.
METHODS: 100 patients being evaluated for various cosmetic procedures were included in the study. Standard pre-operative photographs were obtained. Various eyelid (palpebral fissure, palpebral height, palpebral inclination, pupil to midline of the face, pupil to medial canthus, pupil to lateral canthus, medial limbus to medial canthus, lateral limbus to lateral canthus, marginal reflex distance 1, marginal reflex distance 2, lid margin to the supratarsal crease, orbital fissure to upper / lower lids at various points) and eyebrow (nasal eyebrow, medial eyebrow, lateral eyebrow) measurements were obtained. Right eyelid / eyebrow measurements were compared to the left eyelid / eyebrow measurements.
RESULTS: Mean age was 36.5. Most prominent asymmetric eyelid measurements were pupil to midline of the face (mean difference 1.38 mm), medial canthus to the medial limbus (mean difference 1.10 mm). Most prominent asymmetric eyebrow measurement was lateral eyebrow (mean difference 1.22 mm). 97% of the patients had at least one asymmetric measurements with difference of 1 mm or more.
CONCLUSION: Pre-existing asymmetry is very common and if this is detected and brought to the patients' attention it is the patients' flaw. Otherwise it will be attributed to the surgery. Additionally, any asymmetry can usually be corrected or improved when it is detected through careful preoperative analysis and being aware of the prevalence of this abnormality.


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