There may be other more educated replies, but here is my take on the differences.
First, bearing on top or bottom, whether it is a router table or hand-held router, and whether it is designed to make a straight cut or a shear cut as in a up cut or down cut- distinguishes a flush trim bit from a pattern bit (which is also a form of flush trim bit.)
As far as bearing diameter, as long as it is the same as the cutters it will make a flush cut.
Now as to the size of both- a smaller flush trim bit/bearing will get deeper into and make a smaller radius inside corners and contours, and the opposite is true.
A small bit/bearing will also be more affected by surface irregularities where the bearing rides and more likely to transfer those irregularities to the edge being trimmed. A small bearing on soft wood can actually make its own irregularities - depressions- if you are not careful.
I'm sure there are other reasons like tangential cutter speed and cutting resistance, etc. Usually taller flush trim bits have smaller diameters to reduce amount of stock taken in one bite and hence reduce the demand on the router motor.