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Standardized landmarks were positioned, and data measurements in the periocular region were obtained from these images using VAM software and assessed using intraclass correlation coefficients (ICC) for reliability. Absolute differences and asymmetry index between the right and the left periocular region were calculated with a focus on gender and age-related differences.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Result<\/jats:title>\n                <jats:p>Fissure height asymmetry was positively correlated with age (<jats:italic>p &lt; 0.01<\/jats:italic>). Furthermore, reflex distance asymmetry was positively correlated with age in the elderly group (<jats:italic>p &lt; 0.05<\/jats:italic>). Absolute differences of upper eyelid crease were 0.65 \u00b1 0.79 mm for females and 0.90 \u00b1 0.94 mm for males (<jats:italic>p &lt; 0.05<\/jats:italic>). In the elderly group, the absolute differences of reflex distance were 0.664 \u00b1 0.471 mm for males and 0.470 \u00b1 0.408 mm for females (<jats:italic>p &lt; 0.05<\/jats:italic>), while the absolute differences of fissure height were 0.619 \u00b1 0.469 mm and 0.436 \u00b1 0.372 mm, respectively (<jats:italic>p &lt; 0.05<\/jats:italic>). All measurements had an inter-rater ICC and intra-rater ICC between 0.761 and 0.957.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Periocular asymmetry is more prominent in older and male people. 3D photogrammetry is a reliable tool to detect periocular asymmetry and might provide an accurate and effective reference for periocular cosmetic, plastic, and reconstructive surgery in the clinical routine.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Level of Evidence I<\/jats:title>\n                <jats:p> This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors. <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"http:\/\/www.springer.com\/00266\">www.springer.com\/00266<\/jats:ext-link>.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00266-024-04125-8","type":"journal-article","created":{"date-parts":[[2024,5,28]],"date-time":"2024-05-28T21:02:19Z","timestamp":1716930139000},"page":"4489-4499","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Periocular Asymmetry Index in Caucasian Populations Using Three-dimensional Photogrammetry Assessment"],"prefix":"10.1007","volume":"48","author":[{"given":"Xiaojun","family":"Ju","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander C.","family":"Rokohl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wanlin","family":"Fan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Simon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xueting","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xincen","family":"Hou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nexhat","family":"Ukehajdaraj","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philomena A.","family":"Wawer Matos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9195-0770","authenticated-orcid":false,"given":"Yongwei","family":"Guo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ludwig M.","family":"Heindl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,5,28]]},"reference":[{"issue":"2","key":"4125_CR1","first-page":"136","volume":"131","author":"M Komori","year":"2009","unstructured":"Komori M, Kawamura S, Ishihara S (2009) Averageness or symmetry: which is more important for facial attractiveness? 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