The Importance and the Unimportance of Symmetry

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This podcast is talking about the importance of symmetry or the unimportance of symmetry and how I think about symmetry when it comes toward facial plastic surgery, as well as facial cosmetic enhancement. So the start with the lesson is that I always say the two sides of the body are not the same. It can never be made the same. And I say this every day to patients who come in and wanting symmetry. And it’s not that I don’t care about symmetry, especially when I’m doing rhinoplasty. I’m always focused on symmetry. You know, I’m doing a facelift, I’m constantly focused on an eyelid surgeries. Of course, I’m measuring symmetry out eye bags, I have the exact amount of fat on both sides I’m looking at. So I’m obsessed with symmetry. I’m constantly looking at if one side looks worse than the other. Can I improve this side to make it look better?

Example, a lady just yesterday, she came in, I did fillers only on the right side of her face. And that sounds crazy. Why would I do that? Would I make her more asymmetric? In fact, no, I made her more symmetric and actually what I didn’t like where all the shadows and dense on the right side of her face and made her look worse. And so once I fixed that right side fillers, almost always loosely down the right side, she immediately looked better. So it’s not that I don’t care about symmetry. I’m focused on symmetry. I fix it all the time, but it’s not entirely treatable. So when your focus is on symmetry versus my focus and my focus on symmetry, great, I will work on it all day long, but when you’re focused and you come in saying, Hey, I am bothered by symmetry, I want this improved, most likely you’ll never be happy. The reason for this is that I can never get the one side I was looking like the other. Even if you start with the principal, Dr. Lam, I’m not that picky. I just want better, well, that’s true. But what I’ve noticed is once someone’s number one or number two stated goal is symmetry they always look and go, gosh, he could put a little bit more filler there. Couldn’t he make this a little bit better? And the answer is very hard to, and then you risk overfilling it and you’re still not good enough. And it’s interesting, the most reasonable individuals that when they state the goal of symmetry, oftentimes they fail to be happy. Now, there are some exceptions to this rule. The exception would be someone that has a deformity. And so there’s a difference between a symmetry that’s mild where all of us have it.

I always say, if you want to look scary, take your Photoshop of your face and flip one side over the other. And you’re going to notice that when the two sides are exactly symmetric, you actually look frightening because we’re not supposed to be perfectly symmetric, but the goal is reasonable symmetry where I can improve symmetry. Cause symmetry does look better if I can improve it. But you know, if you’re really wanting perfect symmetry, it’s just unattainable and it just something that will drive you crazy. Cause I won’t get a good enough. And the other thing is people always say, well, the nature, you know, animals are more attractive when they’re more symmetric. Well, that’s probably the case, but I always like to talk about balance. And the balance is how, like for example, a nose of the tip is too large versus the bridge or the bridge is too large to the tip or, you know, there’s unbalanced aging with the neck as far older than the face.

Those unbalanced elements are really what I focus on a face is too wide versus too narrow. But of course I’m focused on symmetry as well. But the key is to understand symmetry is not fixable. It’s not as important as you think, but it is about balance. And so getting back to the point that I started, I forgot to continue this. I apologize. Which is when is symmetry important when there’s a deformity? And I can’t recall in this article, I read many years ago about exactly how many centimeters it was that that defined an unnatural result. Something that looked off, some of that looks like a stroke. For example, someone with Bell’s palsy, where that when they smile and you look totally crooked when there’s a bad rhinoplasty and something is way off deviation, those kinds of asymmetries that really detract from you are definitely worth saying, okay, that’s a priority.

Let’s work on this. But in most cases, when someone comes in, they go, you know, my eyelids slightly different from this one, you know, should I do Botox for that? Well then you got to keep Botoxing to make it even or eyelid surgery. If you say, well, my eyelid is hanging more. Should you take a lot more skin away from that side? The problem is oftentimes that drags the brow down, the skin comes back and it’s still not there. So when you focus on a symmetry, oftentimes the goal of doing so will make you not happy when I’m done, even though I am focused on symmetry. So I hope this podcast about symmetry is understandable that you’re going understand that my goal and focus is symmetry, but your goal and focus should not be symmetry because you may not be happy when I’m done.

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