Abstract
IntroductionIn evaluation for blepharoplasty, patients often desire improved cosmesis and/or correction of visual field deficits. However, patients are usually unaware of eyelid or brow asymmetry. Furthermore, the prevalence of eyelid and brow asymmetry is infrequently reported in the medical literature.PurposeTo determine the prevalence of brow and eyelid asymmetry in patients evaluated for upper lid blepharoplasty.MethodsOne hundred consecutive patients evaluated for upper lid blepharoplasty were included in the study. Standard pre-operative photographs were taken of all patients using consistent background and photographic equipment. Two of the authors (KM & AM) independently recorded the margin pupil (MPD), central eyebrow (CED), nasal eyebrow (NED) and temporal eyebrow (TED) distances. To test the inter-observer reliability, the senior author (SMT) recorded the same measurements for 10% of randomly selected patients. We calculated 95% confidence intervals to compare symmetry between the right and left sides.ResultsOne hundred patients (94 female, mean age 57.7) were included in the study. The average MPD, CED, NED and TED distances were 0.55 mm (95% CI 0.45-0.65), 1.77 mm (95% CI 1.47-2.07), 1.34 mm (95% CI 1.14-1.54), and 1.78 mm (95% CI 1.50-2.06), respectively. Ninety-three percent of patients had at least one asymmetric measurement of greater than 1 mm. Seventy-five percent of patients studied had at least one measurement greater than 2 mm while 37 percent had at least one greater than 3 mm.ConclusionBrow and eyelid asymmetry is common in patients being evaluated for upper lid blepharoplasty. The facial plastic surgeon should identify and document facial asymmetry pre-operatively, and discuss it with prospective blepharoplasty patients. This will improve informed consent and patient expectations.
Highlights
In evaluation for blepharoplasty, patients often desire improved cosmesis and/or correction of visual field deficits
Brow and eyelid asymmetry is common in patients being evaluated for upper lid blepharoplasty
There is no clear consensus on what degree of asymmetry is of clinical importance, some authors report that facial asymmetry as little as 1 mm is of significance and warrants attention [7,8,9]
Summary
In evaluation for blepharoplasty, patients often desire improved cosmesis and/or correction of visual field deficits. Purpose: To determine the prevalence of brow and eyelid asymmetry in patients evaluated for upper lid blepharoplasty. Patients are usually unaware of eyelid or brow asymmetry [1,2,3]. This is interesting to note, given the importance of facial symmetry in defining beauty [4,5]. It is important to identify and inform the patient of the presence of eyelid and brow asymmetry [1,6]. There is no clear consensus on what degree of asymmetry is of clinical importance, some authors report that facial asymmetry as little as 1 mm is of significance and warrants attention [7,8,9]
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