Symmetry is viewed as healthy and beautiful, but very few of us have near-perfect symmetry. True symmetry isn’t even skin deep as there are bony differences under our facial skin and around our eyes. Furthermore, there are areas deep to the skin where fatty pockets can descend or be more prominent on one side or the other. Similarly, there can be muscle asymmetries underlying what we see on our faces that can make dissimilarities between the two sides.
Around the eyes, subtle differences of the eyelid positions relative to the globe surface can result from orbital asymmetry (bony eye socket; e.g., one socket larger or deeper than the other), globe vertical or horizontal position differences between the two sides, inflammatory conditions (e.g., thyroid disorders), old trauma (can cause fat atrophy in eye socket, eyelid scarring issues), UV (sun) damage, medical treatments (certain medications, radiation), and age-related issues (stretching of the tissues).
If significant asymmetry is noted then it is important to identify any potential serious cause(s), and finally address the separate asymmetries individually to achieve the best and most “balanced” result. Dr. Burroughs doesn’t perform the exact same surgery across different patients or from one side to the other to achieve the most balanced results and improvement of obvious asymmetries.
If you have noticeable asymmetries it is important during your consultation to discuss this with Dr. Burroughs. It is critical to know, which areas of your face your prefer. During your exam, Dr. Burroughs will look at your pupils to look that they are level with one another as this can be a clue to underlying orbital asymmetry. Palpation of the bony prominences and contours around the eyes and face is also performed to identify any subtle deep differences that could be causing overlying superficial asymmetry. Sometimes these asymmetries are best seen by tilting your head backward and Dr. Burroughs will look from below (“worms eye view”). Specific eyelid measurements and evaluation include: looking at the distance between the eyebrow and upper eyelid crease; distance between the upper eyelid crease and the eyelashes; eyelid margin to pupil reflex distance; the horizontal and vertical eyelid and exposed globe surface measurements; presence of any scleral show (white part of eye) either above or below the cornea; the slope of the eyelids; upper and lower eyelid contours (convex, concave, flat); and protuberance or lack thereof the cheek bones and forehead relative to the eyes.
If the globes (eye) are remarkably different then consideration should be given performing orbital imaging (e.g., CT). When it comes to actually correcting asymmetries, it is important to realize that disparate surgery from one side to the other may be required. During healing, often the side that required “more work” may swell more and mask the final result until the swelling and bruising resolves. Makeup, hair-styling, and brow plucking can also help minimize facial and eye differences. Dr. Burroughs’ prior experience as a microsurgeon has fueled an already built-in desire for the smallest attention of detail and post-surgical symmetrical success. Because symmetry portrays health, attractiveness, and vitality it is critical to do all that is possible to achieve the most symmetrical result possible.