title: Asymmetry in upper blepharoplasty: a retrospective evaluation study of 365 bilateral upper blepharoplasties conducted between January 2004 and December 2013.
abstract: BACKGROUND
  This study was undertaken to evaluate dermatochalasis, eyebrow position, and (a)symmetry in both sides in patients before and after bipolar coagulation-assisted orbital (BICO) septo-blepharoplasty, so as to carry out further investigation if these aforementioned aspects improve, persist, or even worsen after this procedure.
  
  
  METHODS
  The preoperative and postoperative photographs of 365 patients were evaluated for the (asymmetry in) degree of skin surplus, eyebrow height, and eyelid fissure height (EFH). The degree of skin surplus was scored using a five-point grading scale (0 = no, 1 = minimal, 2 = moderate, 3 = evident, and 4 = severe skin surplus). For eyebrow height and EFH, respectively, the distance was measured between the lower bound of the eyebrow and the center of the pupil and between the upper and lower lash line.
  
  
  RESULTS
  On both the right and left upper eyelids, the skin surplus was significantly lesser postoperatively than preoperatively (p = 0.000). Furthermore, the asymmetry in skin surplus between the right and left upper eyelid was significantly lesser postoperatively (p = 0.000). The eyebrow height was significantly lower on both the right and left sides postoperatively than preoperatively (p = 0.000). EFH was significantly higher postoperatively than preoperatively in both the right and left eyes (p = 0.000). Therefore, the asymmetry in EFH between the right and left eyes was significantly lesser postoperatively (p = 0.000).
  
  
  CONCLUSIONS
  A significant decrease in skin surplus and eyebrow height and a significant increase in EFH were observed in patients after BICO septo-blepharoplasty. However, a significant reduction in (the prevalence of) asymmetry in skin surplus and EFH was observed after the procedure.
  
  
  METHODS
  Level IV, case series.
authors.affiliation: Department of Plastic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Shariselle M W
authors.initials: SM
authors.lastname: Pool
authors.affiliation: Department of Plastic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Bergman Clinics, Private Clinics for Aesthetic Surgery, Heerenveen and Zwolle, The Netherlands. Electronic address: b.van.der.lei@umcg.nl.
authors.forename: Berend
authors.initials: B
authors.lastname: van der Lei
mesh_terms: D000328:Adult; D000368:Aged; D019882:Blepharoplasty; D005143:Eyelids / Q000033:anatomy & histology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Asymmetry; Blepharoplasty; Eyebrow; Upper eyelid